FIVE YEARS LATER: CAN WOMEN IN LOS ANGELES COUNTY, CALIFORNIA GET ADEQUATE PILL SUPPLIES?

OBJECTIVE: To determine if pharmacies in Los Angeles County had implemented legislation that had been in effect since 2017 requiring insurance companies based in California to fully reimburse for 13 cycles of oral contraceptives dispensed at once.

STUDY DESIGN: We conducted a secret shopper telephone survey of Los Angeles County pharmacies nearly five years after the legislation went into effect. We chose the categorial state family program (Family PACT) to represent all programs covered by the legislation. Representative numbers of pharmacies were randomly selected in each of Los Angeles County's eight service planning areas (SPAs) in proportion to the numbers of women living in each area. We asked pharmacies if they would fill a prescription for a year's supply of contraception all at once for a patient enrolled in Family PACT.

RESULTS: We contacted a total of 582 pharmacies and excluded the 150 unresponsive pharmacies. Of the 432 pharmacies contacted, only 3.2% said they would dispense a one-year supply of pills at once to a patient enrolled in this representative program. Nearly 50% explicitly said they would not dispense 13 cycles at one time regardless of the prescription. There were no differences in dispensing practices by pharmacy type or by SPA location.

CONCLUSION: Despite legal requirements that state-based insurance programs reimburse for dispensing one-year supplies of pills all at once, only 3.2% of surveyed pharmacies in Los Angeles County said they would comply.

IMPLICATIONS: Collaboration among physicians, pharmacies, and patients is needed to improve dispensing practices. A starting point would be to make the default option be to routinely prescribe 13 cycles. Education of all three groups, along with enhanced insurance company oversight will be needed to achieve lower unintended pregnancy rates associated with providing adequate contraceptive supplies.