Pack of birth control pills on a table with floral tablecloth

Extended Contraceptive Access

Answers for health care providers about prescribing extended contraception supplies.

by Nicole Cieri-Hutcherson, PharmD, BCPS, NCMP

published 06/14/24

Reducing barriers to contraception is critical in improving birth control access and supporting reproductive well-being. One legislative and regulatory policy reform aimed at reducing barriers to contraceptive access is increasing or extending quantity limits on contraceptive supplies covered by health care plans and insurance providers.

What is extended contraception access?

Typically, insurance plans cover a one to three-month supply of hormonal contraceptive supplies at the pharmacy at a time. With extended contraceptive access, pharmacies provide up to a 12-month supply of hormonal birth control, covered by insurance. Research found that providing 12-month extended contraceptive access reduced undesired pregnancy rates by about 30% compared with 1- or 3-month supplies.

Why would someone want an extended supply of birth control?

Getting multiple packs of birth control pills, rings, or patches can save time by reducing the number of times someone has to go to the pharmacy to pick up their prescription, which can be especially important for people who have irregular schedules, college students, or people who live further from a pharmacy. Already having your next pack of pills or box of patches when you need to start them can decrease the chances of a gap in birth control use, making birth control overall more effective at preventing pregnancy. It can make using hormonal birth control more private because it reduces the number of time you have to go and get your birth control from the pharmacy. On the other hand, when getting an extended supply of birth control, people need to think about when and how they are going to store their method, both to keep it private and to ensure correct storage throughout the year.

Where is extended contraceptive access available?

At least 26 states and the District of Columbia require insurers to increase the number of months for which they cover prescription contraceptives at one time. In most cases, legislation requires 12 months of contraceptive access. Current states that offer extended contraceptive access include California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, South Carolina, Texas, Vermont, Virginia, Washington, West Virginia. Power to Decide has more about your state’s extended contraceptive access. here.

Is extended contraception happening?

Yes and no. Despite these state initiatives, a recent scan of states with 12-month mandates found that 12-month prescription utilization rates were low. In addition, insurers in some states mandate patients receive a smaller supply (such as three months) of contraception before a 12-month supply is provided. This suggests that there is still room for improvement in the implementation of extended contraceptive access.

Is extended access the same as pharmacist provision of contraception?

In almost 75% states and Washington DC, legislation has been enacted (or is in progress) allowing pharmacists to prescribe contraception. While policies differ from state to state, most states allow pharmacists to provide a 12-month supply pursuant to a standing order, state-wide protocol, or collaborative practice agreement. A recent study found that patients who received contraception from a pharmacist were more likely to receive a six-month supply compared to those receiving contraception from other healthcare providers.

Bottom line

Extended contraceptive access is an important strategy for increasing convenience. It has the potential to improve patient satisfaction and prevent unintended pregnancy. In more than half of states, insurers are required to cover extended contraception supplies. However, uptake of these services has been low, either due to insurers' non-adherence, prescribers' lack of knowledge, or other reasons.

Nicole Cieri-Hutcherson (she/her) is a clinical pharmacist specializing in internal medicine and reproductive health. She practices in acute care at Buffalo General Medical Center and is a clinical assistant professor at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in Buffalo, NY. Her passion is reproductive health, specifically contraceptive care, menopause management, and drug selection during pregnancy and lactation. At home, she’s mom to 4 beautiful kiddos and enjoys photography and baking.
read more about:barriers to access,birth control,Reproductive Well-Being
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