Increase Access to Contraception - Revision history

G.Lehrman at 19:21, 7 November 2021

2021-11-07T19:21:04Z

G.Lehrman at 19:20, 7 November 2021

2021-11-07T19:20:48Z

G.Lehrman at 02:59, 17 October 2021

2021-10-17T02:59:45Z

G.Lehrman at 02:57, 17 October 2021

2021-10-17T02:57:24Z

G.Lehrman at 02:57, 17 October 2021

2021-10-17T02:57:01Z

G.Lehrman at 02:49, 17 October 2021

2021-10-17T02:49:27Z

G.Lehrman at 02:47, 17 October 2021

2021-10-17T02:47:15Z

G.Lehrman at 02:46, 17 October 2021

2021-10-17T02:46:15Z

G.Lehrman at 02:45, 17 October 2021

2021-10-17T02:45:33Z

G.Lehrman at 02:40, 17 October 2021

2021-10-17T02:40:44Z

@@ Line 56: / Line 56: @@
 &nbsp;
 == LARCs ==
-Increasing access to Long Acting Reversible Contraceptives (LARCs) could be a key part of a strategy. Since 2007, researchers have seen a sharp rise in LARCs, such as intrauterine devices and implants. These forms of birth control last for years once inserted and prevent pregnancy for more than 99 percent of users. That helps explain why they're a big part of the story behind America's plummeting unintended pregnancy rate. <ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>&nbsp;One of the biggest obstacles to LARC use, historically, has been price. Planned Parenthood has estimated that IUDs can cost between $500 and $900 out of pocket. Insurance plans tended to charge patients more for IUDs than for birth control pills, just because the devices have such high upfront costs.<ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>&nbsp;&nbsp;[http://www.latimes.com/health/la-he-0528-birth-control-20160515-snap-story.html This article] makes some interesting points and has information on the relative effectiveness of different types of contraceptives.<br/> &nbsp;
+Increasing access to Long Acting Reversible Contraceptives (LARCs) could be a key part of a strategy. Since 2007, researchers have seen a sharp rise in LARCs, such as intrauterine devices and implants. These forms of birth control last for years once inserted and prevent pregnancy for more than 99 percent of users. That helps explain why they're a big part of the story behind America's plummeting unintended pregnancy rate. <ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>&nbsp;One of the biggest obstacles to LARC use, historically, has been price. Planned Parenthood has estimated that IUDs can cost between $500 and $900 out of pocket. Insurance plans tended to charge patients more for IUDs than for birth control pills, just because the devices have such high upfront costs.<ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>&nbsp;&nbsp;[http://www.latimes.com/health/la-he-0528-birth-control-20160515-snap-story.html This article] makes some interesting points and has information on the relative effectiveness of different types of contraceptives.
 == Hormone-releasing Implants ==

@@ Line 74: / Line 74: @@
 Healthcare providers or clinics can join a Group Purchasing Organization (GPO) to get lower costs on birth control<br/> Afaxys is a pharma company that produces birth control pills, but they also have a Group Purchasing Organization that provides discount pricing on Bayer IUDs.
 == Other Barriers to Access ==
 Approximately 1 in 7 ob/gyns believe pelvic inflammatory disease is a significant risk of IUD use, despite substantial research to the contrary.<ref>Luchowski, A.T., et al. (2014). Obstetrician-Gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Contraception 89.</ref>
 &nbsp;

@@ Line 2: / Line 2: @@
 Intro paragraph
+&nbsp;
 = Introductory Paragraph =
@@ Line 16: / Line 17: @@
 **Half of the 320,000 women in Medicaid in Tennessee received an opioid prescription in 2016<sup class="reference"><ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref></sup>
 **Only 3% of them use a reliable birth control method<sup class="reference"><ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref></sup>
 **Their general knowledge of birth control is very low<sup class="reference"><ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref></sup>
 = Key Information =
@@ Line 23: / Line 24: @@
 == Prevention through Contraception ==
 === Long-Acting Reversible Contraception (LARC) ===
@@ Line 37: / Line 37: @@
 The number of babies born with NAS has dropped nearly 90 percent in one year in counties that have the program.<br/> Tennessee Department of Health officials are sharing the project’s success. Some 41 local jails and methadone clinics now work with county health officials to make available free IUDs. The project is paid for by federal funds for incarcerated women who don't have private insurance or have lost TennCare, which automatically ends during incarceration. Officials stress that the choice to obtain long-acting and reversible contraceptives is up to each incarcerated woman.<ref>https://www.tennessean.com/story/news/2017/02/04/iuds-inmates-seen-tool-combat-opioid-crisis/97056396/</ref><br/> <br/> The Access and Resources in Contraceptive Health (ARCH) Patient Assistance Program provides Bayer IUDs (Kyleena, Mirena, and Skyla) at no cost to women in the United States who do not have either private health insurance or Medicaid coverage for Bayer IUDs and who meet all other program eligibility requirements. Please note that while Bayer provides Bayer IUDs at no cost to patients, patients may incur other costs&nbsp;such as insertion and removal costs. Please speak with your insurance company or your healthcare provider for more information.<ref>http://www.archpatientassistance.com/</ref><br/> <br/> "A Step Ahead" In East Tennessee - With an appointment for free birth control (LARC), will provide a free "Well Woman's" visit, including a pregnancy test and STI test. If you are over 21 and your medical provider deems it medically necessary, you may also receive a free PAP test. They also provide transportation.<ref>http://www.astepaheadeasttn.org/faq.html</ref>
 == Offer Contraception at Pain Management/Addiction/Methadone/Suboxone clinics ==
@@ Line 46: / Line 47: @@
 Contraceptive counseling and access to contraceptive services should be a routine part of substance use disorder treatment among women of reproductive age to mitigate the risk of unplanned pregnancy.<ref>https://www.regulations.gov/document?D=SAMHSA-2016-0002-0001</ref>
+&nbsp;
 = Relevant Research =
@@ Line 57: / Line 55: @@
 See this article on [https://www.bedsider.org/features/224-gold-standard-birth-control-the-iud-and-the-implant preferences and effectiveness of different birth control options].&nbsp;
 == LARCs ==
@@ Line 62: / Line 61: @@
 Increasing access to Long Acting Reversible Contraceptives (LARCs) could be a key part of a strategy. Since 2007, researchers have seen a sharp rise in LARCs, such as intrauterine devices and implants. These forms of birth control last for years once inserted and prevent pregnancy for more than 99 percent of users. That helps explain why they're a big part of the story behind America's plummeting unintended pregnancy rate. <ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>&nbsp;One of the biggest obstacles to LARC use, historically, has been price. Planned Parenthood has estimated that IUDs can cost between $500 and $900 out of pocket. Insurance plans tended to charge patients more for IUDs than for birth control pills, just because the devices have such high upfront costs.<ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>&nbsp;&nbsp;[http://www.latimes.com/health/la-he-0528-birth-control-20160515-snap-story.html This article] makes some interesting points and has information on the relative effectiveness of different types of contraceptives.<br/> &nbsp;
 == Hormone-releasing Implants ==
@@ Line 81: / Line 81: @@
 &nbsp;
 == Contraceptive Counseling ==
@@ Line 88: / Line 89: @@
 == Statistics ==
 *A study of 946 women who were using opioids who gave birth revealed that&nbsp;86% reported that the pregnancy was unintended.<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052960/</ref>
 == Potential Barriers ==
@@ Line 94: / Line 95: @@
 "For example, the ACOG supports placement of LARC devices during the immediate postpartum period to improve the use of LARC among postpartum women;&nbsp; however, bundled payments for delivery create a relative financial disincentive to place LARC devices at the time of delivery.<ref>https://pediatrics.aappublications.org/content/139/3/e20164070</ref> State Medicaid programs play a critical role in ensuring access to highly effective contraception at the time when it is desired, including the time of delivery. However, recent research suggests that states are variable in aligning financial incentives to ensure access to LARC methods if elected at the time of delivery." <ref>Pace, L.E., Dusetzina, S.B., Fendrick, A.M., Keating, N.L., and Dalton, V.K. The impact of out-of-pocket costs on the use of intrauterine contraception among women with employer-sponsored insurance. Medical Care. 2013; 51: 959–963</ref><br/> <br/> Patient contraceptive selection is sensitive to copayment. A 2010 analysis confirmed that employer-based plans display significant variation in copayments by contraceptive method, with LARC methods being the most expensive in terms of upfront costs to patients.<ref>Dusetzina, S.B., Dalton, V.K., Chernew, M.E., Pace, L.E., Bowden, G., and Fendrick, A.M. Cost of contraceptive methods to privately insured women in the United States. Women's Health Issues. 2013; 23: e69–71</ref> The Medicaid program has always required that family planning services be fully covered for patients without cost sharing.<ref>National Women's Law Center. (2015). Fact sheet: Contraceptive coverage in the health care law: Frequently asked questions. Accessed August 24, 2015.</ref>&nbsp;The Patient Protection and Affordable Care Act (ACA) similarly required new private health plans to provide no-cost coverage for all FDA-approved contraceptives.<ref>https://www.patientassistance.bayer.us/</ref>
-= Promising Programs =
+= Impactful Federal, State, and Local Policies =
 == NAS Primary Prevention Initiative ==
@@ Line 114: / Line 122: @@
 *PowerPoint presentation - to educate community partners <span style="color: #ff0000">[contacted for resource]</span>
 *Pamphlet - to educate community partners <span style="color: #ff0000">[contacted for resource]</span>
 *Presentation - conducted to inmates on NAS and how it can be prevented <span style="color: #ff0000">[contacted for resource]</span>
 == emPOWERhealthUSA ==
@@ Line 125: / Line 134: @@
 This patient assistance program provides Bayer IUDs (intrauterine devices), Kyleena, Mirena, and Skyla, at no cost to eligible women.<ref>https://www.patientassistance.bayer.us/</ref>&nbsp;Eligible women include those who do not have either private health insurance or Medicaid coverage for Bayer IUDs and who meet all other program eligibility requirements. Kyleena and Mirena can help prevent pregnancy for up to 5 years and Skyla up to 3 years.<ref>https://www.patientassistance.bayer.us/</ref>
+&nbsp;
 = Sources =

← Older revision		Revision as of 02:57, 17 October 2021
Line 45:		Line 45:

	Contraceptive counseling and access to contraceptive services should be a routine part of substance use disorder treatment among women of reproductive age to mitigate the risk of unplanned pregnancy.<ref>https://www.regulations.gov/document?D=SAMHSA-2016-0002-0001</ref>		Contraceptive counseling and access to contraceptive services should be a routine part of substance use disorder treatment among women of reproductive age to mitigate the risk of unplanned pregnancy.<ref>https://www.regulations.gov/document?D=SAMHSA-2016-0002-0001</ref>
		+

	= Impactful Federal, State, and Local Policies =		= Impactful Federal, State, and Local Policies =

← Older revision		Revision as of 02:57, 17 October 2021
Line 4:		Line 4:


−	= ~~Overview~~ =	+
		+	= Introductory Paragraph =

	Family planning and preconception care for women who use opioids are considered an important strategy to reduce the incidence of neonatal abstinence syndrome (NAS).<span style="display: none;"> </span><sup class="reference"><ref>https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm</ref></sup><span style="display: none;"> </span> "CDC and the Office of Population Affairs of the U.S. Department of Health and Human Services recommend that health care providers support family planning services, which include preconception services, pregnancy intention screening, and contraceptive counseling to prevent unintended pregnancy by increasing access to the full range of contraceptive methods, including long-acting reversible contraception (e.g., intrauterine devices and implants)."<sup class="reference"><ref>Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-4).</ref></sup>		Family planning and preconception care for women who use opioids are considered an important strategy to reduce the incidence of neonatal abstinence syndrome (NAS).<span style="display: none;"> </span><sup class="reference"><ref>https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm</ref></sup><span style="display: none;"> </span> "CDC and the Office of Population Affairs of the U.S. Department of Health and Human Services recommend that health care providers support family planning services, which include preconception services, pregnancy intention screening, and contraceptive counseling to prevent unintended pregnancy by increasing access to the full range of contraceptive methods, including long-acting reversible contraception (e.g., intrauterine devices and implants)."<sup class="reference"><ref>Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-4).</ref></sup>

@@ Line 35: / Line 35: @@
 The number of babies born with NAS has dropped nearly 90 percent in one year in counties that have the program.<br/> Tennessee Department of Health officials are sharing the project’s success. Some 41 local jails and methadone clinics now work with county health officials to make available free IUDs. The project is paid for by federal funds for incarcerated women who don't have private insurance or have lost TennCare, which automatically ends during incarceration. Officials stress that the choice to obtain long-acting and reversible contraceptives is up to each incarcerated woman.<ref>https://www.tennessean.com/story/news/2017/02/04/iuds-inmates-seen-tool-combat-opioid-crisis/97056396/</ref><br/> <br/> The Access and Resources in Contraceptive Health (ARCH) Patient Assistance Program provides Bayer IUDs (Kyleena, Mirena, and Skyla) at no cost to women in the United States who do not have either private health insurance or Medicaid coverage for Bayer IUDs and who meet all other program eligibility requirements. Please note that while Bayer provides Bayer IUDs at no cost to patients, patients may incur other costs&nbsp;such as insertion and removal costs. Please speak with your insurance company or your healthcare provider for more information.<ref>http://www.archpatientassistance.com/</ref><br/> <br/> "A Step Ahead" In East Tennessee - With an appointment for free birth control (LARC), will provide a free "Well Woman's" visit, including a pregnancy test and STI test. If you are over 21 and your medical provider deems it medically necessary, you may also receive a free PAP test. They also provide transportation.<ref>http://www.astepaheadeasttn.org/faq.html</ref>
 == Offer Contraception at Pain Management/Addiction/Methadone/Suboxone clinics ==
-The feasibility of delivery of family planning services at addiction treatment clinics is being actively explored, as seen from a study completed in West North Carolina.<ref>https://sys.mahec.net/media/onlinejournal/Contraceptive Choices.pdf</ref>
+The feasibility of delivery of family planning services at addiction treatment clinics is being actively explored, as seen from a study completed in West North Carolina.<ref>https://sys.mahec.net/media/onlinejournal/Contraceptive%20Choices.pdf</ref>
 Offer contraception planning in non-traditional venues, such as a pediatric clinic within a drug treatment facility.&nbsp;<ref>https://doi.org/10.1080/15332985.2011.575723</ref>&nbsp;A barrier is staff education and comfort discussing the issue. Education and availability of appropriate staff would be paramount.

@@ Line 112: / Line 112: @@
 *Pamphlet - to educate community partners <span style="color: #ff0000">[contacted for resource]</span>
 *Presentation - conducted to inmates on NAS and how it can be prevented <span style="color: #ff0000">[contacted for resource]</span>
 == emPOWERhealthUSA ==
-<span style="background-color: #ffffff; font-family: lato,'helvetica neue',helvetica,arial,sans-serif; font-size: 14px"><span style="background-color: #ffffff; font-family: lato,'helvetica neue',helvetica,arial,sans-serif; font-size: 14px"><span style="background-color: #ffffff; font-family: lato,'helvetica neue',helvetica,arial,sans-serif; font-size: 14px">[http://www.empowerhealthusa.com/our-work.html emPOWERhealthUSA] has a program that provides telehealth coaching on birth control (among other things) to help more women get LARCs or make other informed decisions on birth control, with a focus on women who are using opioids.</span></span></span>
+<span style="background-color: #ffffff; font-family: lato,'helvetica neue',helvetica,arial,sans-serif; font-size: 14px"><span style="background-color: #ffffff; font-family: lato,'helvetica neue',helvetica,arial,sans-serif; font-size: 14px"><span style="background-color: #ffffff; font-family: lato,'helvetica neue',helvetica,arial,sans-serif; font-size: 14px">emPOWERhealthUSA has a program that provides telehealth coaching on birth control (among other things) to help more women get LARCs or make other informed decisions on birth control, with a focus on women who are using opioids.<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref></span></span></span>
 == Access and Resources in Contraceptive Health (ARCH) Patient Assistance Program ==

@@ Line 77: / Line 77: @@
 &nbsp;
 == Contraceptive Counseling ==
-EmpowerHealth USA provides a [http://www.empowerhealthusa.com/our-work.html telehealth option] for contraception counseling.<ref>http://www.empowerhealthusa.com/our-work.html</ref>
+EmpowerHealth USA provides a telehealth option for contraception counseling.<ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref>
 == Statistics ==

@@ Line 1: / Line 1: @@
 Return to&nbsp; [[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]
 Intro paragraph
@@ Line 12: / Line 13: @@
 *The statistics of a study in Eastern Tennessee were alarming:
-**Half of the 320,000 women in Medicaid in Tennessee received an opioid prescription in 2016<sup class="reference"><ref>http://www.empowerhealthusa.com/our-work.html</ref></sup>
+**Half of the 320,000 women in Medicaid in Tennessee received an opioid prescription in 2016<sup class="reference"><ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref></sup>
-**Only 3% of them use a reliable birth control method<sup class="reference"><ref>http://www.empowerhealthusa.com/our-work.html</ref></sup>
+**Only 3% of them use a reliable birth control method<sup class="reference"><ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref></sup>
-**Their general knowledge of birth control is very low<sup class="reference"><ref>http://www.empowerhealthusa.com/our-work.html</ref></sup>
+**Their general knowledge of birth control is very low<sup class="reference"><ref>https://www.venturenashville.com/empower-health-sets-12m-raise-for-push-into-self-pay-nad-infusion-space-cms-1917</ref></sup>
 = Key Information =

@@ Line 57: / Line 57: @@
 Increasing access to Long Acting Reversible Contraceptives (LARCs) could be a key part of a strategy. Since 2007, researchers have seen a sharp rise in LARCs, such as intrauterine devices and implants. These forms of birth control last for years once inserted and prevent pregnancy for more than 99 percent of users. That helps explain why they're a big part of the story behind America's plummeting unintended pregnancy rate. <ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>&nbsp;One of the biggest obstacles to LARC use, historically, has been price. Planned Parenthood has estimated that IUDs can cost between $500 and $900 out of pocket. Insurance plans tended to charge patients more for IUDs than for birth control pills, just because the devices have such high upfront costs.<ref>https://www.vox.com/2016/3/2/11148108/unplanned-pregnancy-larc-iud</ref>&nbsp;&nbsp;[http://www.latimes.com/health/la-he-0528-birth-control-20160515-snap-story.html This article] makes some interesting points and has information on the relative effectiveness of different types of contraceptives.<br/> &nbsp;
 == Hormone-releasing Implants ==
-[https://www.nexplanon.com/static/pdf/combinedlabelfile.pdf NEXPLANON] is a hormone-releasing birth control implant for use by women to prevent pregnancy for up to 3 years.<br/> &nbsp;
+[https://www.nexplanon.com NEXPLANON] is a hormone-releasing birth control implant for use by women to prevent pregnancy for up to 3 years.<br/> &nbsp;
 == Non-Hormone IUDs ==