Director's Policy Corner

In our ongoing series, we dive into different policies that shape the women's health landscape in Oregon and beyond. This edition focuses on addressing better access to birth control. 

Studies show that women are more likely to keep taking short-acting hormonal birth control (the pill, patch or ring) when they have at least a six-month supply. Historically, clinicians could, though rarely did, prescribe 12 months’ worth of contraception, but insurers would only cover smaller amounts. This limited patients to one- or three-month options at the pharmacy, requiring multiple trips over a year. 

In 2016, Oregon lawmakers wanted to reduce this common barrier to access. They passed a law that required insurance companies cover a full 12-month supply of birth control. The change meant many groups had to change how they operated: 

• Insurance companies needed to comply with the 12-month coverage. 
• Clinicians needed to change how they write prescriptions to ensure a full 12 months was dispensed. 
• Pharmacists needed to dispense the full supply. 

Researchers asked: Did the 2016 Oregon law change the amount of birth control people received? 

Analysis of the effect of the 2016 Oregon law

Researchers looked at data from January 1, 2013 through December 31, 2018. This allowed them to compare three years before and three years after the law went into effect. They wanted if there was any difference in how much birth control supply people received. 

The study looked at over 630,000 prescriptions for short-acting hormonal contraceptives. Before the new law, only 3.5% of Oregon women using this form of contraception received a 12-month supply. This number only bumped up slightly – to 3.7% – after the policy change. However, researchers noted a few interesting differences: 

• Women who previously got only one month of coverage became more likely to get two or three months after the policy change. 
• Nearly one out of three women who get their birth control at a Title X clinic (federally funded community health clinics) received a 12-month supply.  
• The chance of getting a 12-month supply was nine times higher for those with Medicaid than those with private insurance. 
• The study authors think that these differences may be the result of Title X clinics and Medicaid programs being more aware of government changes that can affect health care. 

"Increasing the amount of short-acting contraceptives dispensed is a simple way to promote both reproductive autonomy and health," says Maria I. Rodgriguez, M.D., M.P.H., director of the OHSU Center for Reproductive Health Equity, who led the study.  "Dispensing a 12-month supply is safe, effective, and should be the evidence-based standard of care."

Why did the new law have little impact on the amount dispensed overall?

The new law had consequences for insurance companies that did not comply. Even after the policy change, more than eight out of 10 Oregon women receive their contraception in a supply of three months or less. Some of the reasons for this include: 

• Patients may not have been aware of the law. 
• Clinicians may not have known about the 12-month option or offered it during counseling. 
• Pharmacists who were unaware of the policy change may not have been willing to fill longer prescriptions. 
• Self-insured plans are exempt from state law. They represent 43% of Oregon’s privately insured population. 

Overall, the researchers argue that “low rates of 12-month supplies of oral contraception represent missed opportunities to promote reproductive autonomy.” For this policy change to be effective, many groups need to update their approach to providing birth control. Perhaps most importantly, patients also need to know they have the right to coverage for a full year. 

“Passing a policy is not enough to improve health outcomes,” says Dr. Rodriguez. “We need full, equitable implementation of the policy change through outreach to consumers, clinicians, pharmacists and insurers, with mechanisms to hold companies accountable if they don’t comply.”