17α-hydroxyprogesterone caproate access in the Louisiana Medicaid population

Preterm birth and its associated neonatal morbidities remain pertinent health care and economic issues in the United States. Progesterone supplementation in the form of 17α-hydroxyprogesterone caproate has been reported to reduce the risk for recurrent preterm birth in women with a prior spontaneous preterm delivery, but several barriers contribute to its underutilization. The Affordable Care Act has increased the number of women receiving insurance coverage for pre- and perinatal care. However, the increase in insurance coverage has not necessarily facilitated access to standard therapies such as progesterone for the prevention of preterm birth. Data from Louisiana illustrate this point, and the state has responded by developing educational programs and the nation's first pay-for-performance strategy targeting the initiation of progesterone therapy.