OBJECTIVES: One provision of the Patient Protection and Affordable Care Act (PPACA) requires that most insurers make prescription contraceptives—including refillable and long-acting reversible contraceptive methods (LARCs)—available at no out-of-pocket cost to beneficiaries.  The objective of this study was to determine if the implementation of the mandate increased contraceptive utilization. METHODS: We conducted a retrospective analysis using integrated pharmacy and medical claims for three cohorts of commercially-insured females aged 15 to 49. Each cohort (n= 360143, n=352,169, and n=391,138) was continuously enrolled for 12-month periods, respectively. “Pre-PPACA-Period 1” (January 1, 2011 to June 30, 2011) considered cost and utilization two years prior to PPACA. “Pre-PPACA-Period 2” (January 1, 2012 to June 30, 2012) looked at the year prior to PPACA implementation, and the “Post-PPACA Period” (January 1, 2013 to June 30, 2013) captured the early experience immediately after implementation of the coverage mandate. Two pre-PPACA-periods allowed for better understanding of underlying secular trends occurring prior to the mandate. The incidence of new refillable and LARC methods, discontinuation and switching patterns and cost were measured across each time period. RESULTS: The incidence of refillable contraceptive use increased minimally: from 3.45% in the first half of 2011 to 3.59% in the first half of 2012, and to 3.72% in the first half of 2013. The incidence of LARC use increased substantially (44.4% from 0.50% to 0.65% between the first half of 2011 and the first half of 2013). The initiation rate of LARCs was significantly higher after the mandate compared to previous periods (OR=1.45, 95% CI =1.36-1.54), possibly due to increased switching from refillable to LARC methods. CONCLUSIONS: We found little evidence that the PPACA contraceptive coverage mandate rule has yet resulted in meaningful increases in refillable contraceptive use, but it was associated with an increase in the initiation of LARCs.