EXPANDING ACCESS TO LONG-ACTING REVERSIBLE CONTRACEPTIVES: A STATE-LEVEL BUDGET IMPACT MODEL OF SOUTH CAROLINA
Author(s)
Amy Caldwell, MD, MS1, Ashley Brant, DO, MPH2, Kimberly LeMoine, MD3, Peggy Ye, MD, MPH4, Adam Kasle, Bachelor5, Jade Reynolds, BSc6, Amy Tung7, Scott Ramsey, MD, PhD8, Kristina Rosa C. Bolling, BA, MPH, PhD9, Andrea Henkel, MD, MS10;
1Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA, 2Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA, 3Mercy Hospital St. Louis, St Louis, MO, USA, 4Department of Obstetrics and Gynecology, School of Medicine, Georgetown University, Washington DC, DC, USA, 5Curta, Washington, DC, USA, 6Curta Inc, Johannesburg, South Africa, 7Huntington Beach, CA, USA, 8Curta, Seattle, WA, USA, 9Bayer Pharmaceuticals, Brandon, FL, USA, 10Stanford University, Stanford, CA, USA
1Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA, 2Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA, 3Mercy Hospital St. Louis, St Louis, MO, USA, 4Department of Obstetrics and Gynecology, School of Medicine, Georgetown University, Washington DC, DC, USA, 5Curta, Washington, DC, USA, 6Curta Inc, Johannesburg, South Africa, 7Huntington Beach, CA, USA, 8Curta, Seattle, WA, USA, 9Bayer Pharmaceuticals, Brandon, FL, USA, 10Stanford University, Stanford, CA, USA
OBJECTIVES: Long-acting reversible contraceptives (LARCs) are among the most effective forms of contraception. Immediate postpartum (IPP) placement—providing LARC prior to hospital discharge—supports individuals who wish to avoid gaps in contraceptive coverage and reduce unintended pregnancies. In 2012, with a goal of increasing access to desired IPP LARC, South Carolina adopted a policy to separate Medicaid reimbursement of IPP insertion of LARCs from the global maternity fee. This budget impact model (BIM) estimates the economic impact of unbundled IPP LARC payment from a state perspective.
METHODS: The BIM was developed from the perspective of the state of South Carolina to compare a scenario implementing the unbundling policy with one maintaining bundled payment over a 5-year horizon. The cohort included Medicaid enrollees of reproductive age (18-44) and their newborn children up to age 5. The model captured direct healthcare costs of contraception, pregnancy, childbirth, and postpartum care as well as indirect costs of productivity loss due to pregnancy and childcare as well as state-funded childcare. Costs were collected from Medicaid fee schedules, national cost databases, and published literature. Outcomes included IPP LARC insertions, unintended pregnancies prevented, total net cost, and total budget impact per state resident and impacted postpartum Medicaid enrollee.
RESULTS: Compared with the bundled payment scenario, unbundling resulted in 2,863 additional IPP LARC insertions and 1,303 unintended pregnancies prevented among 19,884 postpartum Medicaid enrollees. Despite increased LARC payments (+$4,936,066), the estimated net savings to South Carolina was $9,103,059, primarily driven by reductions in pregnancy and birth costs (-$8,878,141). Annual savings equated to $0.64 per state resident and $169.58 per impacted postpartum Medicaid enrollee.
CONCLUSIONS: Unbundling Medicaid reimbursement for desired IPP LARC increases IPP LARC insertion rates, reduces unintended pregnancies and provides overall savings from the perspective of the state of South Carolina, supporting the economic value of this policy approach to reducing unintended pregnancies.
METHODS: The BIM was developed from the perspective of the state of South Carolina to compare a scenario implementing the unbundling policy with one maintaining bundled payment over a 5-year horizon. The cohort included Medicaid enrollees of reproductive age (18-44) and their newborn children up to age 5. The model captured direct healthcare costs of contraception, pregnancy, childbirth, and postpartum care as well as indirect costs of productivity loss due to pregnancy and childcare as well as state-funded childcare. Costs were collected from Medicaid fee schedules, national cost databases, and published literature. Outcomes included IPP LARC insertions, unintended pregnancies prevented, total net cost, and total budget impact per state resident and impacted postpartum Medicaid enrollee.
RESULTS: Compared with the bundled payment scenario, unbundling resulted in 2,863 additional IPP LARC insertions and 1,303 unintended pregnancies prevented among 19,884 postpartum Medicaid enrollees. Despite increased LARC payments (+$4,936,066), the estimated net savings to South Carolina was $9,103,059, primarily driven by reductions in pregnancy and birth costs (-$8,878,141). Annual savings equated to $0.64 per state resident and $169.58 per impacted postpartum Medicaid enrollee.
CONCLUSIONS: Unbundling Medicaid reimbursement for desired IPP LARC increases IPP LARC insertion rates, reduces unintended pregnancies and provides overall savings from the perspective of the state of South Carolina, supporting the economic value of this policy approach to reducing unintended pregnancies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE171
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
SDC: Reproductive & Sexual Health