Out of pocket spending for Oral contraceptives among women with private insurance coverage after the affordable care act

Abstract Objectives We aimed to identify which types and brands of oral contraceptive pills have the largest shares of oral contraceptive users in large employer plans with out-of-pocket spending and which oral contraceptives have the highest average annual out-of-pocket costs. Study design We analyzed a sample of medical claims obtained from the 2003–2018 IBM MarketScan Commercial Claims and Encounters Database (MarketScan), which is a database with claims information provided by large employer plans. We only included claims for women between the ages of 15 and 44 who were enrolled in a plan for more than half a year as covered workers and dependents. To calculate out-of-pocket spending, we summed copayments, coinsurance, and deductibles for the oral contraceptive prescriptions. Results We found 10% of oral contraceptive users in large employer plans still had out-of-pocket costs in 2018. Oral contraceptives with the largest share of users with annual out-of-pocket spending are brand name contraceptives with generic alternatives. The three contraceptives with the highest average annual out-of-pocket spending were brand name contraceptives without generic alternatives. Three of the ten contraceptives with the largest shares of users who have annual out-of-pocket spending and three of the ten contraceptives with the highest average annual out-of-pocket spending contain iron. Conclusions Women with health insurance are still paying out-of-pocket for oral contraception and future research should investigate which health plans have fewer fully covered contraceptives and effective modes of educating providers and patients about how to maximize the no-cost coverage benefit that has been extended to women. Implications The Affordable Care Act eliminated out-of-pockets costs for contraception for many insured women. However, some women still pay out-of-pocket for certain oral contraceptive brands and types that may have covered alternatives. Providers and patients could benefit from more education on how to maximize the no-cost coverage benefit extended to women.