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, 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.
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, whereas 13 did not cover LARC services at all. There was not a statistically
significant difference in LARC coverage between public and private plans.
Conclusion
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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Article info
Publication history
Published online: August 08, 2019
Footnotes
Aletha Akers is a paid consultant on the Merck HPV advisory board, the Association of Reproductive Health Professionals HPV advisory board, has an investigator-initiated grant from Bayer Healthcare, and receives salary support from the Templeton Foundation for her work at the Children's Hospital of Philadelphia's Center for Parent and Teen Communication. The remaining authors indicate no conflicts of interest.
Identification
Copyright
© 2019 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
