More than 19 million women in the United States live in contraceptive deserts1—areas with insufficient access to the full range of contraceptive methods—and this burden disproportionately affects women of color,2 who also tend to report more negative health care experiences overall.3 To help address this crisis, one promising policy reform is to extend quantity limits on supplies of contraceptives covered by health care plans and insurance programs such as Medicaid and private insurers. However, policymakers must be aware of, and work to address, common challenges to implementation.
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Challenge: Provider awareness
A common barrier to widely implementing 12-month dispensing policies is a lack of awareness, education, and training initiatives that are needed to educate providers and pharmacists on new policies. To address this implementation barrier, policymakers may want to consider the following actions:
- Create a robust alert and notification system to increase awareness of new policies and laws, such as email alerts and notifications that contain a printable, informational flier and copy of the new policy.
- Provide formal training opportunities, including consideration of appointing a working group or task force to develop and oversee training program opportunities and compliance.
Challenge: Patient awareness
Another barrier is patient education and awareness. Similar to the above recommendations, states must also tailor their educational campaigns to keep patients who may use contraceptives informed of changes, while also affirming patients’ right to advocate for themselves:
- Fund and adequately staff hotlines with staff who are knowledgeable of contraceptive care services.4
- Use a multifaceted approach to notify insured patients of changes, including email, regular mail, and alert notification systems.
Challenge: Technology adaptation and medical management
A third barrier is that while innovative technologies have made patient record management more efficient, they can also be slow to uptake and reflect new administrative policies. To address this, states and the medical field should work together:
- Facilitate smooth changes to EMR software that coincide with policy changes, including by ensuring that systems do not default to the standard one- or three-month supply.
Challenge: Transparency and accountability
Another barrier to one-year contraceptive dispensing is a dearth of accountability and research on the effectiveness of some dispensing policies. New policies will only be effective with coordinated dissemination of information and measurable, actionable changes, such as the following:
- Procure research and create data teams and contracts with third-party professionals to conduct independent assessments and implementation evaluations.
- Issue all plan letters (APLs) and guidance on best practices to provide clarification regarding contraceptive quantity limits and supplies.
Challenge: Fears of contraceptive waste
Finally, one remaining barrier to implementation is the concern that dispensing a one-year supply of contraceptives at one time can lead to product waste. To address this, states can help promote a broader understanding of the benefits of a 12-month supply, including:
- Share research that demonstrates that one-year supplies resulted in lower costs and fewer unintended pregnancies and that benefits far outweigh those of potential product waste.5
Conclusion
One-year dispensing is a crucial policy option that can significantly increase contraceptive access. One-year supply policies can help mitigate some of the burdens associated with monthly contraceptive prescribing and dispensing and bolster access for the millions of women who use monthly birth control options. When implemented effectively and to scale, one-year supply policies could help ensure that women can decide when or when not to have children and promote bodily and reproductive autonomy. Policymakers can look to some of the states mentioned in the full report6 as models on how to initiate and design a one-year program that is tailored properly to their respective state.