Who Is Still Paying Out-of-Pocket for Their IUDs Despite the ACA Contraceptive Coverage Requirement? Analysis of a Large National Cohort Using Claims Data.

OBJECTIVES: 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. STUDY DESIGN: 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. RESULTS: 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). CONCLUSION: 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.