PhD Candidate Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, United States Lexington, United States
Background: Pre-pandemic data suggest that nearly half of US pregnancies are unintended, making contraception access a public health focus. Following the COVID-19 emergency declaration in the US, changes to healthcare delivery were widespread, limiting in-person visits and impacting healthcare accessibility. To mitigate these impacts, Kentucky pharmacists were permitted to autonomously provide 30-day prescription renewals under certain circumstances. As reductions in contraception access result in increases in unintended pregnancies and their associated effects, understanding the impacts of the pandemic on contraceptive use is of concern and has yet to be described.
Objectives: To evaluate the impact of the COVID-19 national emergency on contraceptive dispensing trends in Kentucky.
Methods: Prescription claims data were extracted from the IBM Marketscan Commercial Claims and Encounters Database. Subjects included were enrollees (defined as those with at least 1 day of enrollment in each given week) between the ages of 15-44 with a primary residence located within Kentucky and identified as female in the database. A segmented regression analysis was used for statistical modeling of an interrupted time series (ITS) design to describe changes in the weekly average contraceptive (oral, transdermal, and vaginal) dispensing rate (per 100 reproductive-aged female enrollees) from January 7, 2019 through December 27, 2020. The interruption week was the week of March 16, 2020, the first week of the COVID-19 national emergency in the US. Comparative ITS was used to compare and stratify results by age group (15-20 and 21-44).
Results: A total of 102,289 subjects met study inclusion criteria. The baseline estimated dispensing rate was 1.48 (95% CI: 1.43, 1.53) per 100 reproductive-aged female enrollees with no significant pre-pandemic trend. Following the COVID-19 emergency, an immediate increase of 0.09 (95% CI: 0.01, 0.16) in estimated rate occurred with no significant change in trend. Pre-pandemic estimated rates were lower in the those aged 21-44 compared to those aged 15-20 by an estimated difference of -0.51 (95% CI: -0.61, -0.40). The difference in level change brought on by the emergency was statistically significant between the groups, with an estimated difference of 0.18 (95% CI: 0.02, 0.34), resulting from an immediate increase in estimated rates among those ages 21-44 contrasting with an immediate decrease among those ages 15-20.
Conclusions: Following the COVID-19 national emergency declaration, an immediate increase in estimated contraceptive dispensing rates was seen among a sample of reproductive-aged Kentucky females, likely driven by increases among those ages 21-44. The contribution of Kentucky’s autonomous renewal policy should further be explored.
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