Universal Pharmacare and Contraceptive Dispensations Among Youth.

Abstract

Importance: Previous studies have suggested that removing financial barriers to contraception could help reduce unintended pregnancy.

Objective: To assess whether introduction of universal public funding for prescription contraception in Ontario (OHIP+) for individuals younger than 25 years and the amended program, which limited public funding to those without private insurance (OHIP-), is associated with changes in contraceptive dispensations.

Design, setting, and participants: Interrupted time-series analyses were used to evaluate whether implementation of either policy was associated with changes in monthly contraceptives dispensed. The setting included a national database on contraceptives dispensed from retail pharmacies between September 2016 and February 2020; data analysis was performed from May 2022 to 2024. Participants included Ontario females aged 15 to 24 years to whom prescriptions were dispensed (intervention) vs controls: (1) Canadian females aged 15 to 24 years, excluding Ontario, and (2) Ontario females aged 25 to 49 years.

Exposures: Implementation of free prescription contraception through OHIP+ (January 2018-March 2019) and OHIP- (April 2019-February 2020).

Main outcomes and measures: Monthly dispensations of intrauterine devices (IUDs) and oral contraceptive pills (OCPs) per 1000 females overall and by area-level socioeconomic status (SES).

Results: After OHIP+, there was an immediate level increase in IUDs dispensed to Ontario females aged 15 to 24 years (intervention) of 0.50 (95% CI, 0.15-0.84) vs 0.03 (95% CI, -0.26 to 0.32) in Canadian females aged 15 to 24 years-a relative increase of 0.48 (95% CI, 0.02-0.91). There was an immediate level increase in OCPs dispensed to Ontario females aged 15 to 24 years of 22.3 (95% CI, 14.8-29.8) vs 7.57 (95% CI, 3.07-12.1) in those aged 25 to 49 years-a relative increase of 14.8 (95% CI, 6.15-23.4). There were no statistically significant changes in monthly dispensation trends after OHIP+ and no statistically significant changes after OHIP-. In areas with lower SES, there was a significant increase in the level for IUDs of 0.64 (95% CI, 0.02-1.26) and for OCPs of 13.2 (95% CI, 1.33-25.0) after OHIP+, and a significant decrease in the level for IUDs of 0.82 (95% CI, -1.55 to -0.09) after OHIP- in Ontario vs Canadian females aged 15 to 24 years. No statistically significant changes in IUD or OCP dispensations were observed in areas with higher SES vs controls.

Conclusions and relevance: Results reveal that providing comprehensive and confidential access to prescription contraceptives was associated with increased dispensations among Ontario youth.