Impact of Medicaid Extended Contraceptive Supply Policies on States’ Oral Contraceptive Prescription Duration

• In Event: Evaluating Policies to Improve Access to Contraception in the US

Abstract

Introduction:
Since 2015, clinical guidelines have recommended that clinicians offer patients up to 12 months’ contraceptive supply at the first prescription fill. These extended contraceptive prescription supplies are associated with improved contraceptive continuation rates and reduced risk of unintended pregnancy. Twenty-three states have implemented policies requiring Medicaid to cover extended supplies of contraception at a single dispensation.  
Objective:
We sought to determine if Medicaid extended supply policies were associated with longer average oral contraceptive pill (OCP) prescription lengths.  
Methods:
We used our previously developed Medicaid State Drug Utilization Data (SDUD) Contraception Database, which transforms publicly available SDUD datasets to quantify state-level outpatient contraception utilization in Medicaid. The source data are at the state-year-quarter level from Q3-2017 to Q2-2024. We calculated the state average months’ supply per prescription as the total months’ supply of OCPs divided by the total OCP prescriptions. Medicaid extended supply policy implementation dates came from Power to Decide policy reports. We included OCP prescriptions in 12 states that enacted Medicaid extended supply policies (CO, DE, LA, MA, MI, NM, NJ, NH, NY, RI, SC, VA) and 26 states that did not. We excluded 7 states for data quality issues and 6 states that implemented extended supply policies before Q3-2018 or after Q2-2023 to ensure sufficient pre- and post-treatment data. Because states implemented policies at different times and dynamic treatment effects were expected, we used the Callaway-Sant’Anna staggered difference-in-differences estimator. Our primary model included 38 states without covariates. Model 2 added a binary Medicaid expansion covariate; Model 3 excluded untreated states that required private insurance coverage of extended OCP supplies (nstates=5); and Model 4 excluded states that require Medicaid coverage of 6-month – rather than full-year – OCP supplies (nstates=2). The event-studies for all models failed to find treatment effects in the pre-policy period, supporting the parallel-trends assumption.  
Results:
Our findings show that average prescription lengths in all states increased over time, particularly in 2020 due to COVID policies. However, the increase among states with Medicaid extended supply policies was statistically larger; the average supply per prescription was 6.7 (95% CI: 3.4-10.0) days longer (0.22 months) in states that enacted the policy compared to states that did not. This difference was also significant after including Medicaid expansion status in the model (ATT = 5.9 95% CI: 2.6-9.1), excluding states that require coverage of extended supplies in private insurance only (ATT = 6.4 95% CI: 3.0-9.9), and excluding states with 6-month policies (ATT = 6.6 95% CI: 3.2-10.0). Treatment effects increased with longer implementation and were larger for early-adopter states relative to late-adopters.  
Conclusions:
Findings suggest that extended supply policies may marginally increase state average OCP prescription lengths in Medicaid. Further research should explore whether these effects vary by provider or patient characteristics, and the prescription durations primarily driving the overall increases.

Author

• Emma Mairson, Johns Hopkins University
  Presenting Author