(SLA-004) Increased Continuity of Oral Contraceptive Therapy following Implementation of Extended Days’ Supply Coverage Mandates in the United States

Background: In the United States, insurers typically limit prescriptions to a 30- or 90-day supply with the goal of reducing wastage and managing cost; however, several states have passed legislation to mandate coverage of an extended days’ supply (i.e., a 6- to 12-month supply in a single fill) of oral contraceptives (OCs). While prior work has shown OC continuation rates to be higher among those receiving an extended days’ supply, data also indicate low utilization and awareness following mandate implementation, raising questions regarding the population-level impact of such mandates.

Objectives: To assess for associations between implementation of legislation mandating coverage of extended OC days’ supply and the relative risk (RR) of contraceptive therapy gaps over time.

Methods: This longitudinal observational study was conducted using a quasi-experimental design. Implementation dates of extended OC days’ supply mandates were gathered from existing literature and assessed monthly (from June 1, 2016 through December 31, 2020) using a time-varying indicator variable. Enrollment and prescription claims data for females aged 19-44 with OC claims during the study period were extracted from Merative MarketScan® Commercial Claims and Encounters Database. The outcome of interest was the number of individuals with a gap in OC therapy >7 days in each state-month. Generalized estimating equation Poisson regression modeling was used to assess for associations between mandates and estimated risk of a gap in OC therapy. State-level covariates included in the full model (birth rate, educational attainment rate, and poverty rate) were sourced from publicly available data. Backwards elimination of nonsignificant covariates was used to arrive at the final model.

Results: During the study period, 19 states plus Washington D.C. implemented legislation mandating coverage of an extended OC days’ supply. No differences were found in the RR of a gap in OC therapy at baseline (p = 0.33). The RR of a gap in OC therapy decreased over time among the study population (ß = -0.0039; p<.0001). Among states without mandates, the RR of a gap in OC therapy decreased by 0.4% per month (aRR 0.996; 95% CI 0.996–0.997); however, among those with mandates, the RR decreased by 0.5% per month (aRR 0.995; 95% CI 0.993–0.996) indicating decreased RR among states with mandates (p = 0.0425) vs. those without.

Conclusions: Despite low utilization, extended OC days’ supply mandates are associated with decreases in risk of gaps in contraceptive therapy. Efforts to promote awareness and utilization of extended OC days’ supply prescriptions may serve to increase the magnitude of this impact.