The result, according to the authors of a new research letter published in the Journal of the American Medical Association, was a 32% increase in emergency contraceptive fills at pharmacies compared with other states. In fact, after the policy was implemented, fills for prescription-only ulipristal more than doubled, which accounted for the observed increases in fills for emergency contraceptives.
“Emergency contraceptives are key in preventing pregnancy after unprotected sexual intercourse and contraceptive failure,” wrote researchers from the Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences at the University of Southern California and colleagues.
Background information in the article advised that since 2016, 27 states have enacted pharmacy access policies allowing pharmacists to prescribe oral contraceptives, including emergency contraceptives.
“However, these policies require pharmacists to undergo additional training and patients must complete a health questionnaire,” the authors pointed out. “Given these barriers, many pharmacies do not implement pharmacist-prescribed contraception services. The Massachusetts policy overcomes prescribing barriers by using the state as the prescriber and reduces out-of-pocket costs for levonorgestrel among the insured because prescriptions are covered without cost sharing.”
Their study evaluated the association between Massachusetts’ statewide standing order and emergency contraceptive fills at retail pharmacies. The focus was on 92,500 emergency contraceptive fills between July 2021 and October 2023.
To do that, the researchers used the IQVIA’s National Prescription Audit PayerTrak, which includes 92% of U.S. retail pharmacies, was used. Monthly fill rates for emergency contraceptives (primary outcome) and for ulipristal and prescribed levonorgestrel (secondary outcome) per 100,000 women of reproductive age were calculated for each state between July 2021 and October 2023. The 2021 American Community Survey was used to derive the population of women of reproductive age (15-49 years).
An analysis compared changes in emergency contraceptive fills before (July 2021-May 2022) and after (August 2022-October 2023) the statewide standing order was implemented in Massachusetts and a comparison group composed of Illinois and Connecticut combined. Considered a washout period was the time after the Dobbs v Jackson Women’s Health Organization decision but before the policy change (June 2022-July 2022).
The report noted that while Illinois and Connecticut did not implement statewide standing orders, the two states otherwise acted similar to Massachusetts in their abortion and contraceptive policies, including requiring insurance to cover prescribed emergency contraceptives without cost sharing.
Although monthly fill rates for emergency contraceptives were higher in Massachusetts than comparison states before the statewide standing order was implemented, the findings suggested that trends were similar. The results indicated that before the standing order, 78.5 emergency contraceptive fills per 100,000 women of reproductive age occurred in Massachusetts, increasing to 105.3 after the standing order (difference, 26.8).
In the comparison states, however, there were 45.8 emergency contraceptive fills before and 48.4 after (difference, 2.6). “In the adjusted difference-in-differences analysis, the statewide standing order policy was associated with an additional 25.2 emergency contraceptive fills per 100,000 in Massachusetts vs. comparison states (95% CI, 4.8-27.4; P <.001), a 32.1% increase,” according to the researchers. “There were an additional 31.6 fills per 100,000 for ulipristal (95% CI, 10.0-38.5; P <.001), a 119% increase, but no significant change for prescribed levonorgestrel (–6.4 fills per 100,000; 95% CI, –11.6 to 2.7; P = .25).”
“These findings are consistent with a shift from prescription levonorgestrel to ulipristal, which is effective for pregnancy prevention for up to 5 days (vs. 3 days for levonorgestrel) after unprotected sexual intercourse and is more effective in overweight and obese women,” the authors wrote. “Thus, policies that reduce prescribing barriers may improve access to emergency contraceptives, particularly ulipristal.”
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