Original Report| Volume 32, ISSUE 6, P612-614, December 2019

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

Published:August 08, 2019DOI:


      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, Participants, and Interventions

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

      Main Outcome Measures

      The primary outcome was adherence to the ACA mandate for LARC coverage without cost-sharing.


      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, whereas 13 did not cover LARC services at all. There was not a statistically significant difference in LARC coverage between public and private plans.


      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.

      Key Words

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        • Finer L.B.
        • Zolna M.R.
        Shifts in intended and unintended pregnancies in the United States, 2001-2008.
        Am J Public Health. 2014; 104: S43
        • Winner B.
        • Peipert J.F.
        • Zhao Q.
        • et al.
        Effectiveness of long-acting reversible contraception.
        N Engl J Med. 2012; 366: 1998
        • Finer L.B.
        • Jerman J.
        • Kavanaugh M.L.
        Changes in use of long-acting contraceptive methods in the United States, 2007-2009.
        Fertil Steril. 2012; 98: 893
        • Daniels K.
        • Daugherty J.
        • Jones J.
        • et al.
        Current contraceptive use and variation by selected characteristics among women aged 15-44: United States, 2011-2013.
        Natl Health Stat Report. 2015; 86: 1
        • Kavanaugh M.L.
        • Jerman J.
        • Finer L.B.
        Changes in use of long-acting reversible contraceptive methods among U.S. Women, 2009-2012.
        Obstet Gynecol. 2015; 126: 917
      1. Patient Protection and Affordable Care Act. 42. Public Law, USA2010 (USC §18001.)
        • Vela V.X.
        • Patton E.W.
        • Sanghavi D.
        • et al.
        Rethinking Medicaid coverage and payment policy to promote high value care: the case of long-acting reversible contraception.
        Womens Health Issues. 2018; 28: 137
        • Wong C.A.
        • Merchant R.M.
        • Moreno M.A.
        Using social media to engage adolescents and young adults with their health.
        Healthc (Amst). 2014; 2: 220
        • Fox J.
        • Barfield W.
        Decreasing unintended pregnancy: opportunities created by the Affordable Care Act.
        JAMA. 2016; 316: 815
        • 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
        • Birgisson N.E.
        • Zhao Q.
        • Secura G.M.
        • et al.
        Preventing unintended pregnancy: the Contraceptive CHOICE Project in review.
        J Womens Health (Larchmt). 2015; 24: 349