Who Is Still Paying Out-of-Pocket for Their IUDs Despite the ACA Contraceptive Coverage Requirement? Analysis of a...

After the Affordable Care Act's (ACA's) contraceptive coverage requirement went into effect, out-of-pocket costs fell for all forms of Food and Drug Administration-approved prescription contraception. This analysis examines which subgroups of privately insured women are continuing to pay more than $0 for their intrauterine device (IUD) insertions.

Using 2017-2021 Merative MarketScan Commercial Claims Database, we examined trends in out-of-pocket costs among 727,482 privately insured women. Multivariable analyses modeled the likelihood of paying $0 out-of-pocket (vs. >$0) for the IUD insertion, adjusting for year, age group, IUD type, U.S. census region, and place of service.

Most women (71.5%) paid $0 for their IUD insertion regardless of type. Compared with the 52-mg levonorgestrel (Mirena) IUD users, all others were less likely to pay $0, specifically those with newer to market IUDs (13.5-mg levonorgestrel IUD [Skyla] adjusted odds ratio [aOR] .854 [.832, .876] and 19.5-mg levonorgestrel IUD [Kyleena] aOR .839 [.824, .855]). Independent of IUD type, younger women (<26 years old) were less likely to pay $0 (13- to 17-year-olds aOR .872 [.844, .900]; 18- to 25-year-olds aOR .887 [.876, .899]).

Privately insured women are more likely to pay out-of-pocket if younger or if using a newer to market IUD, specifically the 13.5-mg levonorgestrel IUD (Skyla). Out-of-pocket cost may be a barrier to access for these individuals. Future monitoring is needed to understand the continuing impact of the ACA contraceptive coverage requirement on IUD costs.