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Illinois aiming to ‘make every pregnancy planned’ by increasing access to long-acting reversible contraception

by Deb Miller ~ May 2016 ~ Stateline Midwest »
Illinois is leading the way in adopting Medicaid payment reforms to increase access to long-acting reversible contraception, known as LARCs. LARCs — intrauterine devices, or IUDs, and subdermal contraceptive implants — are highly effective forms of birth control, with a pregnancy rate of less than 1 percent within the first year, according to the Centers for Disease Control and Prevention.
In comparison, oral contraceptive pills have a pregnancy rate of 9 percent and male condoms have a pregnancy rate of 18 percent in the first year. The LARC devices are effective for three to 10 years.
Two years ago, Illinois began implementation of a Family Planning Action Plan. It, in part, increased provider rates and required health plans in the state to submit their family planning policies (including referral policies) with the state.
“[We] wanted to ensure that all Medicaid providers delivered quality, comprehensive family planning services,” Linda Wheal, maternal health program manager for the Illinois Department of Healthcare and Family Services, says of that 2014 plan. More changes (the result of Medicaid state plan amendments and revised state policies) began to take effect last year. These changes:
As part of its efforts to increase same-day LARC insertion by outpatient providers, Illinois is working with pharmaceutical companies to address a financial disincentive that can sometimes stand in the way. LARC devices can cost up to $700, so maintaining an inventory in a physician’s office requires a financial outlay. But without an office inventory, a woman who wants a LARC is required to return to the office a second time — after the provider issues a prescription and orders and receives a single device.
Teva, a pharmaceutical manufacturer of IUDs, has come up with a solution. It provides a unit stocked with multiple IUDs; once a device is removed, electronic scanning technology sends a signal to the distributor to bill the physician.
“My biggest challenge is meeting the demand; every office is looking for one of these units to help their cash flow,” says Nick Penzetta, Teva’s director of market access for the public sector.
According to Penzetta, his company is now looking to see if these units are in settings where the need is the greatest — for instance, sites where many Medicaid-eligible women seek care. When Illinois announced its new Family Planning Action Plan, its stated goal was to make “every pregnancy a planned pregnancy.”
Right now, the unintended-pregnancy rate is near 50 percent. To lower that rate, the state is trying to better ensure access to the most-effective forms of contraception.
“I expect we will see a huge impact five years down the road,” Wheal says. According to Wheal, Illinois Medicaid pays $350 per year for contraceptive costs compared to an average of $12,000 per birth.

 

Brief written by Deb Miller, CSG director of health policy..