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Universal Free Contraception Coverage Policy, Out-of-Pocket Payments, and Costs.

Elizabeth Nethery1,2, Michael R Law3,4, Lucy Cheng1

  • 1Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.

JAMA Health Forum
|May 29, 2026
PubMed
Summary
This summary is machine-generated.

Universal, first-dollar contraceptive coverage significantly reduced patient out-of-pocket (OOP) costs in British Columbia, particularly for young adults. This policy improved contraceptive access by decreasing financial barriers within mixed public-private insurance systems.

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Area of Science:

  • Health Economics
  • Public Health Policy
  • Reproductive Health

Background:

  • Mixed public-private insurance systems in Canada often result in significant out-of-pocket (OOP) spending for contraceptives.
  • Cost-sharing and formulary exclusions create access gaps and inequities for essential reproductive health services.
  • The impact of universal, first-dollar contraceptive coverage on patient and public costs remains unclear.

Purpose of the Study:

  • To evaluate changes in patient OOP costs and payer types following the implementation of universal contraceptive coverage.
  • To compare outcomes under a universal coverage policy versus a mixed public-private insurance system.

Main Methods:

  • Controlled interrupted time-series analysis of aggregate monthly contraceptive prescription data (April 2021-March 2025).
  • British Columbia (BC) served as the intervention province; a synthetic control was modeled using other Canadian provinces.
  • Included reproductive-aged females (15-49 years) with dispensed contraceptives, analyzing OOP vs. insurance payments.

Main Results:

  • The proportion of OOP contraceptive prescriptions in BC decreased by 24.9 percentage points immediately after policy implementation.
  • Two years post-policy, OOP share reduced by 29.5 percentage points overall, with a 33.4 percentage point reduction for ages 20-29.
  • OOP per-capita costs decreased by a mean of $43 per year per contraceptive user, with significant reductions for young adults.

Conclusions:

  • Universal, first-dollar contraceptive coverage substantially reduced OOP payments, especially for young adults aged 20-29.
  • Contraceptives are highly sensitive to insurance gaps; universal coverage mandates are effective in improving access.
  • This policy demonstrates a highly effective strategy to enhance contraceptive access, particularly for young adults lacking comprehensive insurance.