Insurance Plan Adherence to Mandate for Long-Acting Reversible Contraceptives in a Large Pediatric Hospital Network.

TitleInsurance Plan Adherence to Mandate for Long-Acting Reversible Contraceptives in a Large Pediatric Hospital Network.
Publication TypeJournal Article
Year of Publication2019
AuthorsMagoon K, Beamish C, Dowshen N, Akers AY
JournalJ Pediatr Adolesc Gynecol
Date Published2019 Aug 08
ISSN1873-4332
Abstract

STUDY OBJECTIVE: Long acting reversible contraceptives (LARCs) are the most effective form of pregnancy prevention for sexually active adolescents, yet usage rates are low. The Affordable Care Act (ACA) mandated insurers cover LARCs without cost sharing. Compliance with this policy is not well documented. This study assessed LARC coverage by insurers in a large pediatric health system.

DESIGN & SETTING: Between June-August 2016, LARC coverage was assessed through content reviews of insurance websites, formularies, and summaries of benefits for all Pennsylvania Medicaid plans and the top 20 commercial insurers for a large pediatric health system.

MAIN OUTCOME MEASURE: The primary outcome was adherence to the ACA mandate for LARC coverage without cost sharing.

RESULTS: Among the 37 plans (17 public, 20 private), 21 (56.8%) were adherent and 16 (43.2%) were nonadherent. Among nonadherent plans, 3 plans covered LARC services but required cost-sharing, while 13 did not cover LARC services at all. There was not a statistically significant difference in LARC coverage between public and private plans.

CONCLUSIONS: Despite the landmark ACA mandate, insurance coverage of LARCs in pediatric hospitals is low for young women among private and public insurers. Insurer failure to adhere to the ACA among pediatric patients represents a barrier to LARC access for those at high risk of unintended pregnancy.

DOI10.1016/j.jpag.2019.08.002
Alternate JournalJ Pediatr Adolesc Gynecol
PubMed ID31401256