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A recent study conducted by Oregon Health & Science University (OHSU) has uncovered significant gaps in access to long-term contraceptive supplies, revealing that millions of women are still unable to receive the full-year supply of birth control as mandated by state policies. Despite legislation in 19 states requiring insurers to cover a 12-month supply of contraception, the study shows that most patients receive only three months or less of their prescription, leaving them at greater risk for unintended pregnancies.
The study, published in JAMA Health Forum, highlights the lack of full implementation of policies designed to improve access to short-acting hormonal contraception, such as the birth control pill. Although these policies aim to ensure patients receive a 12-month supply at once, OHSU researchers found that nationally, there has been no substantial increase in year-long prescription orders.
“The decision of when or if to become pregnant is deeply personal,” said Dr. Maria Rodriguez, M.D., M.P.H., professor of obstetrics and gynecology at OHSU and director of the OHSU Center for Reproductive Health Equity. “It shouldn’t be impacted by a delay in getting to your pharmacy for a refill or a pill package running out while on vacation.”
One of the major challenges in maintaining contraceptive effectiveness is the frequent breaks in use, often caused by patients running out of their prescription or delays in obtaining refills. According to the study, providing a longer-term supply of contraception – such as six or 12 months – can improve continuous use, reduce interruptions in coverage, and result in significant savings for health systems.
Despite these advantages, OHSU researchers found that the policies in place have not significantly changed prescribing practices. Using a difference-in-difference model, the researchers examined contraceptive prescriptions among nearly 4.8 million Medicaid enrollees aged 18 to 44 in 36 states. Among the 11 states with a 12-month supply policy, the increase in the proportion of contraception dispensed for a full year was less than one percentage point in 10 states, indicating minimal progress.
“Our findings suggest a significant gap in knowledge both for patients and prescribers, and we hope this serves as a call to action to make 12-month supplies the standard prescribing practice,” Dr. Rodriguez said. “This is low-hanging fruit for improving birth control access, especially for people who live in states with more restrictions on reproductive health care.”
For these policies to be truly effective, insurance companies must comply with the new guidelines, clinicians need to adapt their prescribing patterns to offer extended supplies, and pharmacists must dispense the full year’s supply. The research team also emphasized the need for state governments to enforce compliance and for ongoing education efforts to ensure that contraceptive users, healthcare providers, and payers are aware of the policy changes.
Dr. Rodriguez advocates for a federal policy mandating coverage of 12-month contraception supplies, which would require all insurers, including private ones, to provide full-year prescriptions. She also encourages patients to be proactive in discussing contraceptive options with their healthcare providers and advocating for choices that best align with their family planning goals and lifestyle.
“In our current health care landscape, where reproductive rights are constantly under attack, it’s critical to remove barriers and ensure broad access to contraception,” Rodriguez emphasized. “We need providers to make this prescribing practice their default, and patients to know that it’s their right to ask for it.”
This study highlights the urgent need for better policy implementation and enforcement to support reproductive health equity and prevent unintended pregnancies.
