LARC coverage and out-of-pocket costs within 60 days postpartum among commercially-insured women
Awarded 2017
Trainee Grants
Ann Soliman, BS
University of Michigan

Background: Unintended pregnancy is common within two years of childbirth, partly due to inadequate access to long-acting reversible contraception (LARC). Patient out-of-pocket costs for expensive LARC services may limit its use. LARC coverage has increased overall due to the Affordable Care Act but may not extend to postpartum women, given the unique structure of pregnancy coverage. Objective: To evaluate commercial plans’ coverage and cost-sharing for LARC devices placed within 60 days after childbirth. Our specific aims are to examine: 1) the proportion of plans providing full, partial, or no LARC coverage; and 2) determine if the degree of plan coverage is associated with LARC uptake. Methods: Using the Optum Clinformatics Data Mart, a large commercial claims database, we will examine plans with maternity coverage to identify beneficiaries hospitalized for live birth between January-October, 2015 and identify inpatient, outpatient, and pharmacy claims for LARC insertions within 60 days of childbirth and associated healthcare spending. We will categorize plans as providing full LARC coverage (median cost share $0), partial LARC coverage (median cost share $>0), no LARC coverage (all LARC claims denied), or unknown coverage (no submitted LARC claims). We will use descriptive statistics to evaluate LARC-associated healthcare spending and multilevel modeling to determine whether better LARC coverage is associated with likelihood of postpartum LARC use, after controlling for plan-aggregated patient- and plan-level characteristics. Significance: Findings will provide novel understanding about LARC coverage and out-of-pocket spending among commercially-insured postpartum women and facilitate interventions to enhance contraceptive access and reduce unintended pregnancy rates.