Long-acting reversible contraceptive utilization after policy change increasing device reimbursement to wholesale acquisition cost in Louisiana

Published:April 28, 2019DOI:


      Unintended pregnancies, occurring in nearly 1 out of every 2 (45%) pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives, namely intrauterine devices and implants. Inadequate reimbursement for long-acting reversible contraceptive devices may be an access barrier to long-acting reversible contraceptive uptake. In 2014, the Louisiana Department of Health Bureau of Health Services Financing implemented a policy change that increased the Medicaid reimbursement rates for acquiring long-acting reversible contraceptive devices to the wholesale acquisition cost.


      To examine the association of a Medicaid policy change that increased the long-acting reversible contraceptive device reimbursement rate to the wholesale acquisition cost (ie, price set by the manufacturers) on long-acting reversible contraceptive uptake among women at risk for unintended pregnancy.

      Materials and Methods

      This retrospective, repeated cross-sectional study used 2013–2015 Louisiana Medicaid claims data and contraceptive provision measures to assess associations between patient (age, race, urban/rural residence, postpartum status) and provider (urban/rural location, specialty) characteristics and long-acting reversible contraceptive uptake among contraceptive users (N = 193,623) using bivariate and logistic regression analyses.


      After long-acting reversible contraceptive reimbursement increased, there was a 2-fold likelihood increase in use in 2015 vs 2013 (odds ratio, 2.08; 95% confidence interval, 1.69–2.55). Long-acting reversible contraceptive uptake was more likely across all patient and provider subgroups in 2015 vs 2013 but notably among patients receiving contraceptive care from family planning clinics (odds ratio, 3.93; 95% confidence interval, 2.34–6.62).


      Removal of a provider-level financial barrier to long-acting reversible contraceptive provision was associated with increased long-acting reversible contraceptive uptake among women at risk for unintended pregnancy. Efforts to improve long-acting reversible contraceptive access should focus on equitable healthcare reimbursement for healthcare providers of reproductive-aged women.

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        • Finer L.B.
        • Zolna M.R.
        Declines in unintended pregnancy in the United States, 2008-2011.
        N Engl J Med. 2016; 374: 843-852
        • Shah P.S.
        • Balkhair T.
        • Ohlsson A.
        • Beyene J.
        • Scott F.
        • Frick C.
        Intention to become pregnant and low birth weight and preterm birth: a systematic review.
        Matern Child Health J. 2011; 15: 205-216
        • Cheng D.
        • Schwarz E.B.
        • Douglas E.
        • Horon I.
        Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors.
        Contraception. 2009; 79: 194-198
        • Gemmill A.
        • Lindberg L.D.
        Short interpregnancy intervals in the United States.
        Obstet Gynecol. 2013; 122: 64-71
        • Conde-Agudelo A.
        • Rosas-Bermudez A.
        • Kafury-Goeta A.C.
        Birth spacing and risk of adverse perinatal outcomes: a meta-analysis.
        JAMA. 2006; 295: 1809-1823
        • Frost J.J.
        • Sonfield A.
        • Zolna M.R.
        • Finer L.B.
        Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program.
        Milbank Q. 2014; 92: 696-749
        • White K.
        • Teal S.B.
        • Potter J.E.
        Contraception after delivery and short interpregnancy intervals among women in the United States.
        Obstet Gynecol. 2015; 125: 1471-1477
        • Birgisson N.E.
        • Zhao Q.
        • Secura G.M.
        • Madden T.
        • Peipert J.F.
        Preventing unintended pregnancy: the contraceptive CHOICE project in review.
        J Womens Health. 2015; 24: 349-353
        • Ricketts S.
        • Klingler G.
        • Schwalberg R.
        Game change in Colorado: widespread use of long-acting reversible contraceptives and rapid decline in births among young, low-income women.
        Perspect Sex Reprod Health. 2014; 46: 125-132
        • Kavanaugh M.L.
        • Jerman J.
        Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014.
        Contraception. 2018; 97: 14-21
        • Dehlendorf C.
        • Rodriguez M.I.
        • Levy K.
        • Borrero S.
        • Steinauer J.
        Disparities in family planning.
        Am J Obstet Gynecol. 2010; 202: 214-220
        • Potter J.E.
        • Hopkins K.
        • Aiken A.R.
        • et al.
        Unmet demand for highly effective postpartum contraception in Texas.
        Contraception. 2014; 90: 488-495
        • Bergin A.
        • Tristan S.
        • Terplan M.
        • Gilliam M.L.
        • Whitaker A.K.
        A missed opportunity for care: two-visit IUD insertion protocols inhibit placement.
        Contraception. 2012; 86: 694-697
        • Kavanaugh M.L.
        • Frohwirth L.
        • Jerman J.
        • Popkin R.
        • Ethier K.
        Long-acting reversible contraception for adolescents and young adults: patient and provider perspectives.
        J Pediatr Adolesc Gynecol. 2013; 26: 86-95
        • Gavin L.
        • Moskosky S.
        • Carter M.
        • et al.
        Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs.
        MMWR Recomm Rep. 2014; 63: 1-54
        • American College of Obstetricians and Gynecologists
        Committee on Gynecologic Practice Long-Acting Reversible Contraception Working Group. Committee Opinion No. 642: Increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy.
        Obstet Gynecol. 2015; 126: e44-e48
        • Kost K.
        Unintended pregnancy rates at the state level: estimates for 2010 and trends since 2002.
        Guttmacher Institute, New York, NY2015
        • Henry J.
        Kaiser Family Foundation. Louisiana: health status indicators.
        (Available at:)
        Date: 2018
        Date accessed: September 1, 2018
        • Sonfield A.
        • Kost K.
        Public costs from unintended pregnancies and the role of public insurance programs in paying for pregnancy-related care: national and state estimates for 2010.
        Guttmacher Institute, New York, NY2015
        • National Quality Forum
        NQF endorses perinatal and reproductive health measures.
        (Available at:)
        • U.S. Department
        of Health and Human Services, Office of Population Affairs. Clinical performance measures of contraceptive care.
        (Available at:)
        • U.S. Department
        of Health and Human Services, Office of Population Affairs. Most or moderately effective contraceptive methods.
        (Available at:)
        • Handley M.A.
        • Lyles C.R.
        • McCulloch C.
        • Cattamanchi A.
        Selecting and improving quasi-experimental designs in effectiveness and implementation research.
        Annu Rev Public Health. 2018; 39: 5-25
        • Schafer J.L.
        Multiple imputation: a primer.
        Stat Methods Med Res. 1999; 8: 3-15
        • Katz A.
        • Soodeen R.A.
        • Bogdanovic B.
        • De Coster C.
        • Chateau D.
        Can the quality of care in family practice be measured using administrative data?.
        Health Serv Res. 2006; 41: 2238-2254
        • Triebwasser J.E.
        • Higgins S.
        • Secura G.M.
        • Zhao Q.
        • Peipert J.F.
        Pharmacy claims data versus patient self-report to measure contraceptive method continuation.
        Contraception. 2015; 92: 26-30
        • Luchowski A.T.
        • Anderson B.L.
        • Power M.L.
        • Raglan G.B.
        • Espey E.
        • Schulkin J.
        Obstetrician-gynecologists and contraception: long-acting reversible contraception practices and education.
        Contraception. 2014; 89: 578-583
        • Pace L.E.
        • Dusetzina S.B.
        • Keating N.L.
        Early impact of the Affordable Care Act on uptake of long-acting reversible contraceptive methods.
        Med Care. 2016; 54: 811-817
        • O'Brien S.H.
        • Klima J.
        • Reed S.
        • Chisolm D.
        • Schwarz E.B.
        • Kelleher K.J.
        Hormonal contraception use and pregnancy in adolescents with sickle cell disease: analysis of Michigan Medicaid claims.
        Contraception. 2011; 83: 134-137
        • Champaloux S.W.
        • Tepper N.K.
        • Curtis K.M.
        • et al.
        Contraceptive use among women with medical conditions in a nationwide privately insured population.
        Obstet Gynecol. 2015; 126: 1151-1159
        • Frederiksen B.N.
        • Kane D.J.
        • Rivera M.
        • Wheeler D.
        • Gavin L.
        Use of clinical performance measures for contraceptive care in Iowa, 2013.
        Contraception. 2017; 96: 158-165
        • Watts L.A.
        • Thiel de Bocanegra H.
        • Darney P.D.
        • et al.
        In a California program, quality and utilization reports on reproductive health services spurred providers to change.
        Health Aff (Millwood). 2012; 31: 852-862
        • Rankin K.M.
        • Haider S.
        • Caskey R.
        • Chakraborty A.
        • Roesch P.
        • Handler A.
        Healthcare utilization in the postpartum period among Illinois women with Medicaid paid claims for delivery, 2009-2010.
        Matern Child Health J. 2016; 20: 144-153