Long-Acting Reversible Contraceptive (LARC) Utilization After Policy Change Increasing Device Reimbursement to Wholesale Acquisition Cost in Louisiana

Abstract Background Unintended pregnancies, occurring in nearly one out of every two (45%) pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Inadequate reimbursement for LARC devices may be an access barrier to LARC uptake. In 2014, the Louisiana Department of Health Bureau of Health Services Financing implemented a policy change that increased the Medicaid reimbursement rates for acquiring LARC devices to the wholesale acquisition cost. Objectives To examine the association of a Medicaid policy change that increased the long-acting reversible contraceptive (LARC) device reimbursement rate to the wholesale acquisition cost (i.e., price set by the manufacturers) on LARC uptake among women at risk of unintended pregnancy. Study Design This retrospective, repeated cross-sectional study utilized 2013-2015 Louisiana Medicaid claims data and contraceptive provision measures to assess associations between patient (age, race, urban/rural residence, postpartum status) and provider (urban/rural location, specialty) characteristics and LARC uptake among contraceptive users (N=193,623) using bivariate and logistic regression analyses. Results After LARC reimbursement increased, there was a two-fold likelihood increase in use in 2015 vs. 2013 (OR=2.08, 95% CI: 1.69-2.55). LARC uptake was more likely across all patient and provider subgroups in 2015 vs. 2013, but notably among patients receiving contraceptive care from family planning clinics (OR=3.93, 95% CI: 2.34-6.62). Conclusions Removal of a provider-level financial barrier to LARC provision was associated with increased LARC uptake among women at risk of unintended pregnancy. Efforts to improve LARC access should focus on equitable healthcare reimbursement for healthcare providers of reproductive-aged women.