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Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs

Rodriguez, Maria I. MD, MPH; Hersh, Alyssa MPH; Anderson, Lorinda B. PharmD; Hartung, Daniel M. Pharm D, MPH; Edelman, Alison B. MD, MPH

doi: 10.1097/AOG.0000000000003265
Contents: Contraception: Original Research
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OBJECTIVE: To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception.

METHODS: A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted. Secondary outcomes included: costs and quality-adjusted life years (QALYs). Model inputs were obtained from an analysis of Medicaid claims for the first 24 months after policy implementation in Oregon, and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed.

RESULTS: Among Oregon's Medicaid population at risk for unintended pregnancy, the policy expanding the scope of pharmacists to prescribe hormonal contraception averted an estimated 51 unintended pregnancies and saved $1.6 million dollars. Quality of life was also improved, with 158 QALYs gained per 198,000 women. Sensitivity analysis demonstrated that the model was most sensitive to the effect on contraceptive continuation rates. If contraceptive continuation rates among women receiving care from a pharmacist are 10% less than among clinicians, than pharmacist prescription of hormonal contraception will not avert unintended pregnancies.

CONCLUSION: Pharmacist prescription of hormonal contraception averts unintended pregnancies and is cost effective. Full implementation of the policy is needed for maximum benefits. Prospective data on the effect of the policy on contraceptive continuation rates are needed.

Pharmacist prescription of hormonal contraception is a cost-effective strategy for Medicaid to avert unintended pregnancy.

Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.

Corresponding author: Maria I. Rodriguez, MD, MPH, Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code UHN50, Portland, OR 97239; email: rodrigma@ohsu.edu.

This study was partially funded by a grant from the Laura and John Arnold Foundation.

Financial Disclosure Maria I. Rodriguez received money paid to her from Merck, the World Health Organization, and Cooper Surgical. Lorinda Anderson received money paid to her from Haymarket Media Inc. more than 2 years ago for an interview that went towards a newsletter publication. She has also received funds from the American Society of Health Systems Pharmacy (ASHP) for a conference registration and a small travel reimbursement for speaking at a conference. She receives money from the Arthur Foundation, as she is a corecipient on a grant funding a different study. Daniel Hartung received money paid to his institution from AbbVie Pharmaceuticals. He has received money paid to him from MedSavvy. He has received grants from CDC, NIDA, AHRQ, and the National Multiple Sclerosis Society. The other authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews are available at http://links.lww.com/AOG/B371.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.