Check your options to expand IUD access
Your patient is a young mother in a mutually monogamous relationship who cannot tolerate oral contraceptives, has heavy menses, and says she doesn’t want to use an injectable birth control method. She has no medical insurance coverage. What options can you offer her?
If one of your options includes the Mirena intrauterine system (IUS), two avenues of access may be open. The ARCH (Access and Resources in Contraceptive Health) Foundation, a not-for-profit organization with operations in Charlotte, NC, operates a patient assistance program that is designed to assist low-income patients who do not have insurance coverage for the device. The Foundation is funded by Berlex Laboratories of Montville, NJ, which markets the Mirena device.
Berlex Laboratories also has just established a payment plan for the Mirena IUS for those women who are self-paying for the device, says Kim Schillace, Berlex Laboratories’ manager of public relations for female health care. Through an arrangement with TheraCom of Bethesda, MD, which distributes the Mirena IUS to physicians’ offices, women can set up an interest-free plan for the device. The new plan will allow women to pay for the IUS in four payments, which will spread the cost over several months, notes Schillace.
According to A Pocket Guide to Managing Contraception, average wholesale price for the Mirena IUS is $395.1 While Medicaid in 47 states covers IUD insertion and removal, the device’s price tag may be prohibitive for family planning facilities who serve lower-income women who may not be covered by Medicaid.2
The device relies on a slow daily 20-mcg release of the progestin levonorgestrel for its contraceptive efficacy. It has been approved in the United States for five years’ use as a contraceptive. (For more information, see "FDA gives green light to Ber-lex’s Mirena intrauterine system," Contraceptive Technology Update, February 2001, p. 13, as well as "The Levonorgestrel Intrauterine System: An Effective New Contraceptive Option," Contracep-tive Technology Report, May 2001, insert.)
The ARCH Foundation provides assistance on a patient-specific basis according to predetermined eligibility criteria. Financial criteria are based on federal poverty level guidelines.
Patients and providers can talk via telephone with a patient case coordinator, and then patients must fill out a one-page application form to be considered for assistance. (See resources box, p. 10, for contact information.)
The application is reviewed and eligibility is determined within approximately two business days, provided that a complete application is received with patient income information. If the patient qualifies for assistance, the Mirena IUS is shipped to the patient’s health care provider or clinic. If patients do not have insurance coverage, the foundation encourages health care providers to provide insertion of donated Mirena devices free of charge.
Ortho-McNeil Pharmaceutical of Raritan, NJ, offers a variety of options to increase access to its ParaGard IUD, says Kellie McLaughlin, director of global pharmaceutical communications for New Brunswick, NJ-based Johnson & Johnson, Ortho-McNeil’s parent company. However, ParaGard is no longer covered under Ortho-McNeil’s patient assistance program, which provides assistance for qualified patients. The company has opted to offer clinics a discounted price on the IUD, and it also supports Title X pricing, she notes.
References
1. Hatcher RA, Nelson AL, Zieman M, et al. A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation; 2001.
2. Laurence L. Can the IUD make a comeback? Kaiser Daily Reproductive Health Report. Jun 14, 2001. Accessed at: www.kaisernetwork.org/Daily_reports.
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