The Effect of Eliminating Cost Sharing on Adolescent IUD Utilization [6F]

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The Affordable Care Act (ACA) removed major cost barriers by expanding coverage to dependents and eliminating out of pocket costs (OOPC) for IUD placement. Our objective was to characterize the effect of eliminating OOPCs on IUD cost and placement among commercially-insured young women


This study used de-identified data from The Clinformatics™ Data Mart Database to examine changes in cost sharing and IUD placement among commercially-insured women ages 15-26 between 2009 and 2014. IUD placement was identified using ICD-9 and CPT-4 codes. Plans were categorized by cost sharing patterns: $0 OOPC, low OOPCs, and high OOPCs. Multilevel models were used to estimate the effect of cost sharing on IUD placement.


We identified 604 unique plans that were utilized for IUD services in 2009 and 2014. The 75th percentile of OOPCs in 2009 was $241 and dropped to $0 in 2014. Average plan utilization rate increased significantly from 7.4% in 2009 to 10.3% in 2014 (p<.001). When grouped by cost sharing patterns, significant increases in IUD utilization were observed for all groups. However, differences in plan utilization between 2009 and 2014 were not found. IUD plan utilization rate did not differ between plans with high OOPCs in 2009 and $0 in 2014 compared to plans that always had $0 OOPC (difference in slopes=.0115, p=.574).


The elimination of cost sharing did not cause adolescents to increase IUD utilization beyond the general trend. Adolescents may be continuing to go outside their plans to access contraception despite the elimination of cost sharing.

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