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Original Investigation
Health Care Policy and Law
July 8, 2019

Financial Implications of 12-Month Dispensing of Oral Contraceptive Pills in the Veterans Affairs Health Care System

Author Affiliations
  • 1Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 3Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
  • 4Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 5Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Intern Med. 2019;179(9):1201-1208. doi:10.1001/jamainternmed.2019.1678
Key Points

Question  What are the expected financial and reproductive health implications for the Veterans Affairs health care system of implementing a 12-month dispensing option for oral contraceptive pills?

Findings  In this economic decision model built from the Veterans Affairs health system payer perspective using a cohort of 24 309 women, adoption of a 12-month dispensing option for oral contraceptive pills is expected to produce substantial cost savings for the payer compared with standard 3-month dispensing, while reducing unintended pregnancies among women veterans.

Meaning  A 12-month dispensing option for oral contraceptive pills is economically feasible for the Veterans Affairs health system while better supporting women veterans’ reproductive goals and autonomy.

Abstract

Importance  The Veterans Affairs (VA) health care system is the largest integrated health care system in the United States. Like most US health plans, the VA currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills (OCPs). However, 12-month OCP dispensing has been shown to improve continuation of use, decrease coverage gaps, and reduce unintended pregnancy in other practice settings.

Objective  To estimate the financial and reproductive health implications for the VA of implementing a 12-month OCP dispensing option, with the goal of informing policy change.

Design, Setting, and Participants  A decision model from the VA payer perspective was developed to estimate incremental costs to the health care system of allowing the option to receive a 12-month supply of OCPs up front, compared with the standard 3-month maximum, during a 1-year time horizon. A model cohort of 24 309 reproductive-aged, heterosexually active, female VA enrollees who wish to avoid pregnancy for at least 1 year was assumed. Probabilities of continuation of OCP use, coverage gaps, pregnancy, and pregnancy outcomes were drawn from published data. Costs of OCP provision and pregnancy-related care and the number of women using OCPs were drawn from VA administrative data. One-way and probabilistic sensitivity analyses were performed to assess model robustness.

Main Outcomes and Measures  Incremental per-woman and total costs to the VA of allowing for 12-month dispensing of OCPs compared with standard 3-month dispensing.

Results  The 12-month OCP dispensing option, modeled from the VA health system perspective using a cohort of 24 309 women, resulted in anticipated VA annual cost savings of $87.12 per woman compared with the cost of 3-month dispensing, or an estimated total savings of $2 117 800 annually. Cost savings resulted from an absolute reduction of 24 unintended pregnancies per 1000 women per year with 12-month dispensing, or 583 unintended pregnancies averted annually. Expected cost savings with 12-month dispensing were sensitive to changes in the probability of OCP coverage gaps with 3-month dispensing, the probability of pregnancy during coverage gaps, and the proportion of pregnancies paid for by the VA. When simultaneously varying all variables across plausible ranges, the 12-month strategy was cost saving in 95.4% of model iterations.

Conclusions and Relevance  Adoption of a 12-month OCP dispensing option is expected to produce substantial cost savings for the VA while better supporting reproductive autonomy and reducing unintended pregnancy among women veterans.

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