Long-Acting Contraception Rates Rose 49% With No-Cost Policy

After British Columbia (BC) made long-acting reversible contraception (LARC) free in April 2023, LARC dispensations, which had been declining steadily, went up by 49%, data indicated. The findings underscored the importance of removing the cost barrier for birth control, according to the authors.

The data are particularly important because LARC, which includes intrauterine devices (IUD) and subdermal implants, is the most effective type of contraception, study author Laura Schummers, ScD, assistant professor of health outcomes at the University of British Columbia in Vancouver, told Medscape Medical News.

The research was published on July 28 in The BMJ.

Immediate LARC Increase

“These methods are at least 10 times as effective as other kinds of contraception,” Schummers said. With LARC, “less than 1% of users become pregnant each year of use.” For comparison, the pill, patch, or ring have failure rates near 6%-9%, she noted. In addition, LARC can last for 3-10 years, and its effectiveness does not depend on the user.

More than 40% of pregnancies worldwide are unintended, including 48% of pregnancies in North America, according to the researchers. They examined the numbers of monthly dispensations for all contraception prescriptions, including LARC, in the years before and after a universal contraception coverage policy was instituted in BC in April 2023. Under this policy, the public insurer pays 100% of prescription costs.

The researchers tracked contraception prescriptions that were given to 859,845 reproductive-aged female residents of BC (age, 15-49 years) between April 1, 2021, and June 30, 2024. They compared these prescriptions with those given to a control group derived from the nine other Canadian provinces that did not dispense contraception for free. Without this no-cost intervention, most Canadian insurance plans require copayments, coinsurance, or annual deductibles, and many don’t cover contraception at all.

In April 2023, when the new policy took effect, “we saw an immediate increase by over 1050 additional dispensations per month,” Schummers said. “By June 2024, there were almost 1300 additional dispensations per month for LARC that amounted to a 49% increase in what we observed vs what was expected, based on the pre-policy trends. That really tells us there was an unmet need for the most effective forms of contraception and that costs were driving contraceptive choices, as well as contraceptive use overall.”

Upfront costs are likely a barrier to the adoption of LARC, said Schummers. Though prescriptions increased for all forms of contraception, “we found almost all of the increase in use was concentrated in the LARCs,” she said. That difference likely has to do with cost structure. Even though the contraceptive pill is a monthly payment for years, it is a low payment, typically $20-$25. A low payment per month over years may be perceived as easier to pay than the one-time $350-$450 upfront for LARC, said Schummers.

The findings “confirm that this was a smart policy decision,” according to Schummers. They also may help encourage the policy’s adoption in other provinces.

Canada is “in a period of evolving discussions about contraception coverage and prescription coverage more generally,” Schummers observed. BC was the first province to make the policy change, and Manitoba, Yukon, and Prince Edward Island have followed suit.

“But the remaining provinces do not yet have an agreement in place,” Schummers said. “Our study provides timely evidence to support those discussions and to guide decisions to follow what BC has done across all the provinces.”

Promoting LARC Uptake

Commenting on the findings for Medscape Medical News, Dustin Costescu, MD, obstetrician/gynecologist and family planning specialist in Hamilton, Ontario, said that despite LARC methods’ many advantages, many barriers limit its uptake. This study demonstrates the magnitude of the financial barrier and the rapid increase in uptake when it is removed, he said.

“Moving the needle on LARC uptake is not an easy task. With millions of BC residents, increasing LARC uptake by 1.9% means tens of thousands of individuals have accessed an IUD or implant where previously they could not. While not captured in this study, that translates to a reduction of unintended pregnancies, unplanned births, and abortion by a magnitude of thousands.”

One of the reasons the federal government has prioritized universal access to contraception is that access to birth control has demonstrated cost savings globally, Costescu said.

“The work of the authors, many of whom are primarily responsible for the work to build universal coverage in BC, cannot be overstated and demonstrates the need and demand for LARC access in Canada,” he said.

The study was supported by the Canadian Institutes of Health Research. Schummers reported having no relevant financial relationships. Costescu reported relationships with Searchlight, Organon, Bayer, and Duchesnay. 

Marcia Frellick is an independent healthcare journalist and a regular contributor to Medscape Medical News.