Contraception - Maximizing patient access to contraception

Many circumstances affect a woman’s access to contraception. Clinicians can help women solve many of these difficulties prospectively. Several means exist by which clinicians can expedite access to contraceptives; a breast and pelvic examination and screening for cervical cancer and sexually transmitted infections are not necessary prior to instituting contraception. A medical history and blood pressure check are all that are needed before hormonal contraceptives are prescribed (the medical history can be taken by phone and the blood pressure check by the pharmacist). Although contraceptive visits are frequently used for such evaluations, clinicians should not delay prescribing contraception until these can be accomplished.66,67 The Quick Start method has been outlined to facilitate the use of hormonal contraception.68,69,70,71,72 Many women have some health benefits available to them through insurance. In 2002, in the US, the EEOC ruled that an employer’s exclusion of contraceptives from its health insurance plans constituted sexual discrimination in violation of Title VII of the Civil Rights Act of 1964. It further required employers to cover prescription contraception to the same extent that other drugs, devices and preventive care were covered under the employee’s health care plan. Nonetheless, health plans, including state run Medicaid formularies, may offer only a subset of contraceptive products, or “generics” only. Differential co-pays may be required to access certain methods. Often longer acting methods, such as an IUD, may be less expensive over the length of time used, however they may also be associated with higher “up front costs.” Generic OCPs are nearly always as efficacious as brand-name products and have a fairly equivalent safety profile. Pharmacies also control access to at least some extent with some pharmacists either not stocking or refusing to fill prescriptions for EC for example.

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