Yearlong supply of birth control pills cuts cost and unintended pregnancies: JAMA

A new study shows that the yearlong supply of birth control pills cuts cost and unintended pregnancies compared to just three months of contraceptives at a time. When women are given a 12-month supply of oral contraceptives, they are less likely to have an unintended pregnancy than if they need to get refills every three months. 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.

The study has been published in JAMA Internal Medicine.

The common practice of dispensing only three months of pills “is the norm and thought to be a cost-saving measure to prevent wastage of medications that people don’t end up using,” said the study’s lead author, Colleen Judge-Golden, a Ph.D. student at the University of Pittsburgh School of Medicine. “But the concerns about waste are overshadowed by the potential savings from pregnancy-related outcomes. A couple of days of not having the medication can lead to a pregnancy that is not desired.”

While the study was conducted in women who had served in the military, “gaps in contraceptive use are common among women in the general U.S. population as well, and extended dispensing for short-acting hormonal contraception is an evidence-based strategy to help women use these methods consistently when that is their goal,” Judge-Golden said. “As of 2019, 17 states and the District of Columbia have enacted legislation requiring insurers to cover dispensing of 12-month contraceptive supplies at initial fill.”

Judge-Golden and her colleagues used a computer model to look at the impact of reducing the number of times a woman would have to refill her contraceptive prescriptions on the risk of unplanned pregnancies and cost. Data from the VA have shown that 43% of women who receive their oral contraceptives in three-month increments experience at least one gap of at least seven days between refills over the course of a year of use.

The average annual cost per woman was about $700.60 for the 12-month dispensing option, compared with $787.72 for the three-month dispensing option, which meant that on medication costs alone, the VA would save $87.12 per woman, which would add up to more than $2.1 million annually for the 24,309 women vets receiving OCs.

The biggest cost savings would come from reductions in unplanned pregnancies. Annually, 149 unintended pregnancies were expected per 1,000 women with the 12-month option, as compared with 173 per 1,000 with the three-month refill option, for a total reduction of 24 unplanned pregnancies per 1,000 female vets per year. That reduction would translate into 583 unintended pregnancies averted each year if the VA adopted a 12-month dispensing option, Judge-Golden and her colleagues found.

The researchers are hoping the new study will spark changes at the VA, “especially since female veterans have no access to abortion or coverage for abortion even in cases where (the mother’s life is in danger),” said the study’s senior author Dr. Sonya Borrero, director of the Center for Women’s Health Research and Innovation at the University of Pittsburgh and associate director of the VA’s Center for Health Equity Research and Promotion.