Do more pill packs mean fewer pregnancies?
What is your facility's policy on providing multiple pill packs? Results of a new study might make you rethink your strategy. Researchers report that rates of unintended pregnancies and abortions decrease significantly when women receive a one-year supply of oral contraceptives, instead of being prescribed one- or three-month supplies.1
Researchers at the Bixby Center for Global Reproductive Health; the Department of Obstetrics, Gynecology, and Reproductive Sciences; and San Francisco General Hospital, all affiliated with the University of California, San Francisco (UCSF), linked 84,401 women who received oral contraceptives in January 2006 through Family PACT (Planning, Access, Care, Treatment), a California family planning program, to Medi-Cal data showing pregnancies and births in 2006. Through Family PACT, some family planning clinics are able to dispense a one-year supply of pills on-site.
Analysis results showed a 30% reduction in the odds of pregnancy and a 46% decrease in the odds of an abortion in women given a one-year supply of birth control pills at a clinic versus women who received the standard prescriptions for one- or three-month supplies.
While oral contraceptives are highly effective when used correctly, statistics show about half of women regularly miss one or more pills per cycle, a practice associated with a much higher pregnancy rate: 80 pregnancies per 1,000 women in the first year of use.2
Other studies have shown that women will continue on their pill regimens with advance provision of pills, says Anita Nelson, MD, professor in the obstetrics and gynecology department at the David Geffen School of Medicine at the University of California in Los Angeles.3
What's the holdup?
What might impede programs from providing multiple pill packs to contracepting women?
According to an upcoming study that looked at national dispensing trends from 1996-2006, 44% of Pill users obtained one pack per purchase, with 27% receiving 2-3 packs per purchase, and 29% receiving more than four packs per purchase.4
These data indicate that resupply visits are the norm for most women on oral contraceptives, comments Diana Greene Foster, PhD, associate professor in the UCSF Department of Obstetrics, Gynecology, and Reproductive Sciences and director of research, advancing new standards in reproductive health at the university's Bixby Center for Global Reproductive Health. "How many packs women get depends on their source of care," states Foster, lead author of the multiple pill pack research paper. "And every program and insurance plan seems to have its own limit."
Most state Medicaid programs routinely limit the amount of prescription drugs dispensed in pharmacies to a 30- to 34-day supply, notes Foster. Some federally supported family planning waiver programs for low-income women without Medicaid permit clinics to dispense a one-year supply, observes Foster. "For example, waiver programs in California, Oregon, Alabama, Virginia allow this [form of dispensing]," says Foster. "This benefit isn't available in every state, and it doesn't work for women who do qualify for Medicaid or get their prescriptions filled at pharmacies rather than clinics."
What will it take to change dispensing practice? State Medicaid programs, family planning waiver programs, and private health insurance plans could change their policy and allow a one-year supply in recognition of the potential cost savings, reduction in unintended pregnancy, and improvement in quality of care, says Foster.
Earlier analysis by Foster's research team showed that dispensing a year's supply of pills saves money simply by avoiding unnecessary repeat resupply visits.5 The team's new research indicates that savings are likely much greater when the expense of unwanted pregnancies is included. Both in terms of quality of care and cost avoidance, it makes sense to offer one-year contraceptive supplies as a program benefit, says Foster.
If the 65,000 women in the analysis who received one or three packs of pills at a time had experienced the same pregnancy and abortion rates as women who received a one-year supply, almost 1,300 publicly funded pregnancies and 300 abortions would have been averted, according to Foster's research team. "The evidence indicates that health plans and public health programs may avoid paying for costly unintended pregnancies by increasing dispensing limits on oral contraceptives," says Foster. "Improving access to contraceptive methods reduces the need for abortion and helps women to plan their pregnancies."
References
- Foster DG, Hulett D, Bradsberry M, et al. Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies. Obstet Gynecol 2011;117:566-572.
- Hatcher R, Trussell J, Nelson AL, et al. Contraceptive technology. 19th revised ed. New York (NY): Ardent Media; 2007.
- Nelson AL, Pietersz D, Nelson LE, et al. Documented short-term continuation rates for combined hormonal contraceptives in an indigent population with ready access to contraceptive supplies. Am J Obstet Gynecol 2007;196:599.e1-5; discussion 599.e5-6.
- Liang S-Y, Grossman D, Phillips KA. Women's out-of-pocket expenditures and dispensing patterns for oral contraceptive pills between 1996 and 2006. Contraception 2010. Doi:10.1016/j.contraception.2010.09.013.
- Foster DG, Parvataneni R, de Bocanegra HT, et al. Number of oral contraceptive pill packages dispensed, method continuation, and costs. Obstet Gynecol 2006;108:1107-1114.
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