Budget Impact Analysis of Long-Acting Reversible Contraceptives for Prevention of Pregnancy in US Females of Childbearing Age

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Rates of unintended pregnancy (UIP) in the US declined among women of childbearing age (15-44) between 2008 and 2011, but UIP remained most common among women and girls who had lower incomes (i.e., incomes below 100% of the Federal Poverty Level). Additionally, UIP still represent approximately 45% of all US pregnancies. The proportion of unintended pregnancies is even higher in pregnant women with opioid-use disorder, as 9 out of 10 pregnancies are unintended in the population. One potential solution is providing increased access to long-acting reversible contraceptives (LARCs) as these methods are more durable and have higher rates of persistence to therapy compared to other contraceptive methods. The object of this capstone project is to conduct a budget impact analysis that estimates the impact of increasing LARC utilization on total medical costs in opioid using women ages 18 to 44. The model took the perspective of a US payer responsible for both pharmacy and medical claims, has a time-horizon of three years, and measured per-member per-month (PMPM) and aggregate budget impact. The analysis found that the budget impact of increasing LARC utilization by 5% per year resulted in a net savings of $0.10 PMPM with aggregate savings of $1,174,585.23 between current market shares and year 3 market shares. It is worthwhile for health plans of this type to explore reducing barriers to access LARCs, such as reduced copay amounts or enacting community-based initiatives to increase utilization of this specific contraceptive method.



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