Law Requiring 12-Month Scripts for Contraceptives Falls Flat

Howard Wolinsky

February 18, 2022

Updated February 19, 2022 // Editor's note: This story has been updated with comments from Dr Diana Greene Foster of University of California San Francisco. A previous version of the story incorrectly attributed the quote in the final paragraph to Dr Jonah Fleisher. The attribution has been changed to Dr Diana Greene Foster.

An Oregon law allowing women to obtain 12-month supplies of short-acting contraceptives has not led to an increase in these extended prescriptions, researchers have found.

Dr Maria Rodriguez

The 2016 provision was intended to help women avoid breaks in coverage for reproductive care, reduce the burdens of filling prescriptions, and reduce the risk of unintended pregnancy. But the new research shows that, at least in Oregon, the policy has had a marginal effect, according to Maria Rodriguez, MD, MPH, associate professor of obstetrics and gynecology at Oregon Health & Science University, Portland.

After the change, more than 80% of women in Oregon were receiving supplies of short-acting contraceptives – pills, rings, or hormone patches — of 3 months or less. Only 3.7% were receiving12-month supplies, essentially the same as the 3.5% prior to the passage of the bill.

"It was an expected disappointment," said Rodriguez, deputy editor of the Cochrane Fertility Regulation Group at OHSU, whose group reported the findings today in ​​JAMA Health Forum.

Rodriguez said she was pleased to see a significant increase in the number of women receiving a 1-month supply to a 2-3 month supply. One third of the women received full 12-month supplies.

"It is an important improvement. This increase translates to only four trips to the pharmacy every year, as compared with 12," Rodriguez told Medscape Medical News.

The study sample included 639,053 prescriptions among Oregon women, most of whom had private insurance (78.6%) and were living in metro areas (78.6%). Oral contraception was the most commonly prescribed form of birth control (90.8%) in the study population.

Women receiving Medicaid were nine times more likely to receive 12-month supplies than those with private insurance.

Dr Jonah Fleisher

Jonah Fleisher, MD, MPH, an ob/gyn and a complex family planning specialist at the University of Illinois College of Medicine at Chicago, said Medicaid may be quicker than private carriers to bring its policies in line with new legislative requirements.  Moreover, in Oregon, 43% of the privately insured population are covered by self-insured plans, which were exempt from this state law requiring coverage of a 12-month supply, he noted.

Oregon's system also requires a patient to return to their doctor a second time for the larger quantity of contraceptives, which has been shown to improve effectiveness and prevent unplanned pregnancies. "A true requirement to dispense a 12-month supply for new prescriptions may help more people actually receive the intended amount," Fleisher said.

Rodriguez said the study is the first to look at the implementation of similar policies to extend supplies of contraceptives. A total of 20 states and the District of Columbia have implemented policies promoting extended supplies of contraceptives, according to the Guttmacher Institute, a nonprofit which studies and advocates for sexual reproductive health and rights.

"Passage of a law is only the first step of many in improving healthcare services and outcomes. This seems like an obvious point, but in practice, I feel like it is often overlooked," she told Medscape. "One of my motivations in leading this study was a call to action — if we fail to fully implement evidence-based health policy we will not improve public health."

A major obstacle to success with the 2016 law, Rodriguez added, was that the policy was not accompanied with funds to promote awareness of the provision. 

"If women don't know about the law, they won't know it is their right to have an increased supply, prescribers will not be aware they can prescribe it, and pharmacists may be uncomfortable filling it," she said. "For this policy to be fully enacted, there also needs to be outreach to insurance companies, telling them of the change in law and holding them accountable to fulfilling it."

Sonya Borrero, MD, director of the Center for Innovative Research on Gender Health Equity at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, said she believes a federal mandate is necessary to assure equitable access to short-acting contraception regardless of geography or insurer. 

Rodriguez agreed that a uniform policy would be better than the current patchwork system. "Requiring a woman to go to the pharmacy every month to pick up a new pack of pills is bad medicine," she said.

Diana Greene Foster, PhD, professor of obstetrics, gynecology, and reproductive sciences at University of California San Francisco, who has campaigned for the approach of extending contraceptive supplies, said, "What Dr Rodriguez has shown clearly in Oregon is that law change is not enough. Oregon was one of the first states to improve people's contraceptive access by allowing an expanded supply. But this law change was not sufficient to change the practice of clinicians and pharmacists to give people a full year supply."

"The paper is extremely important," Foster said. "We need to have papers that publicize successes and, in this case, an as-yet-unrealized-success. The laws are there but the practices are not."

Rodriguez reported receiving grants from the National Institute of Minority Health & Health Disparities during the conduct of the study and personal fees from the American College of Obstetricians and Gynecologists, Bayer, and Merck & Co. outside the submitted work.

JAMA Health Forum. Published online February 18, 2022. Full text

Howard Wolinsky is a medical writer in Chicago.

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