Contraceptive Prescribing and Dispensing After the Defense Health Agency's Policy Change

Area of Science:

• Public Health
• Reproductive Health
• Health Policy Analysis

Background:

• The Defense Health Agency Procedural Instruction (DHA-PI) 6200.02 was implemented in May 2019 to enhance contraception access and knowledge.
• The impact of DHA-PI 6200.02 on contraceptive prescribing and dispensing practices, particularly extended supply, required evaluation.

Purpose of the Study:

• To assess changes in contraceptive prescribing and dispensing practices following DHA-PI 6200.02 implementation.
• To specifically examine trends in extended day supply for long-acting reversible contraception (LARC), short-acting reversible contraception (SARC), and permanent contraception.

Main Methods:

• Retrospective cohort study using interrupted time-series analysis (January 2016 - September 2022).
• Analysis focused on active-duty servicewomen (ADSW) enrolled in TRICARE.
• Segmented regression models assessed changes in monthly contraceptive supply and utilization rates before and after policy implementation.

Main Results:

• The proportion of SARC users receiving extended supply increased significantly post-policy (1.1% to 5.3%).
• Extended SARC use and dispensed extended SARC showed significant upward trends post-policy.
• Overall extended contraceptive supply across all methods (SARC, LARC, permanent contraception) did not show meaningful change and declined in trend.

Conclusions:

• DHA-PI 6200.02 was associated with improved extended supply access for SARC among ADSW.
• The policy did not yield corresponding increases in overall extended contraceptive supply for LARC or permanent contraception.
• Findings highlight challenges in policy implementation and the need for strategies to ensure comprehensive uptake of contraceptive services.