Center for Health Equity Research and Promotion

Sonya Borrero, MD, MS, attending physician at VAPHS Women's Health Clinic and Associate Director of VA CHERP, in one of the leaders of the VA's new "Birth Control on Demand," which started on May 15, 2021. Now women Veterans receiving care from VA Pittsburgh Healthcare or from the VA Puget Sound Health Care System can access contraceptive counseling and prescriptions directly from a clinical pharmacist, and when clinically appropriate, will also have the (new) option of receiving a 12-month supply of birth control at one visit. This project is one result from VA-funded research by Dr. Borrero and colleagues.

Nearly half of women Veterans who use VA healthcare are of childbearing age and over one-third of their pregnancies are unintended. Like most US health plans, VA currently stipulates a 3-month maximum dispensing limit for all medications, including oral contraceptive pills (OCPs). However, 12-month OCP dispensing has been shown to improve continuation, decrease coverage gaps, and reduce unintended pregnancy in other practice settings. Despite mounting evidence favoring 12-month dispensing strategies for improving contraceptive access and reproductive outcomes, the financial consequences for VA were unclear, but would likely shape policy decisions. Thus, a study led by HSR&D investigator Sonya Borrero, MD, MS, sought to determine the expected financial and reproductive health implications for the VA healthcare system in implementing a 12-month dispensing option for oral contraceptive pills. Investigators developed a decision model – from the VA payer perspective – to estimate incremental costs to the healthcare system of allowing the option to receive 12 months of OCPs upfront, as compared to the standard three-month maximum, over one year. A cohort of 24,309 women was used to calculate total annual costs, based on the number of VA enrollees who filled an OCP prescription during fiscal year 2017.

Findings from this study showed that the adoption of a 12-month dispensing option for oral contraceptive pills would be expected to produce substantial cost savings for VA compared to standard 3-month dispensing, while reducing unintended pregnancies among women Veterans. The 12-month dispensing option would result in anticipated VA cost savings of $87.12/woman/year compared to 3-month dispensing, or an estimated $2,117,800 total saved annually.

Impacts

Through the new 'Birth Control on Demand' project, starting on May 15, 2021, women Veterans receiving care from VA Pittsburgh Healthcare or from the VA Puget Sound Health Care System can access contraceptive counseling and prescriptions directly from a clinical pharmacist, and when clinically appropriate, will also have the (new) option of receiving a 12-month supply of birth control at one visit.

Partners

Project leaders include Dr. Borrero, part of HSR&D’s Center for Health Equity Research and Promotion (CHERP) and the Center for Women’s Health Research and Innovation at the University of Pittsburgh (CWHRI), and Deirdre Quinn, PhD, MSc, MLitt, also part of CHERP and a VA Women’s Health Fellow at Pittsburgh, in addition to Drs. Lisa Callegari, Carolyn Gardella, and Jennifer Chin (a fellow in family planning at the University of Washington) at VA Puget Sound Health Care System and HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care in Seattle, WA and Denver, CO. This multi-site team has collaborated with pharmacists across both sites to implement the demonstration project, which includes a pharmacist training module for contraceptive prescribing, standard operating procedures to guide practice, and an electronic medical record template to capture data. The work is also supported by VA Women’s Health Services as part of larger collaboration to assess and address barriers to contraceptive access in the VA.

Publications

Judge-Golden C, Smith K, Mor M, and Borrero S. Financial Implications of 12-Month Dispensing of Oral Contraceptive Pills in the Veterans Affairs Healthcare System. JAMA Internal Medicine. September 1, 2019;179(9):1201-1208.


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