Low-income women's access to contraception after health care reform in Massachusetts

Objectives: To determine the experiences of low-income women who were eligible for government-subsidized health insurance and seeking contraception in community pharmacies following health care reform (HCR) in Massachusetts, to investigate the transitions experienced by family planning providers following HCR, and to evaluate the availability and ease of navigation of information on the Commonwealth Care plans websites regarding prescription benefits, including contraceptive formularies and copays. Design: Descriptive, exploratory, nonexperimental study. Setting: Massachusetts between August 2008 and March 2009. Participants: Family planning agency and site staff (n = 16) at 15 sites and low-income (<300% federal poverty level) English-and Spanish-speaking women (n = 23 and 29, respectively). Intervention: Commonwealth Care (i.e., government-subsidized insurance plans for low-income residents) websites were reviewed, family planning agency administrators were surveyed, family planning staff were interviewed, and focus groups were conducted among low-income women. Main outcome measures: Experiences of low-income women and family planning providers. Results: Findings from all study components were highly consistent. After reform, family planning staff reported providing more prescriptions for contraception versus providing contraception on site. Many focus group participants and family planning providers felt pharmacy provision of contraception enhanced access as a result of the convenient location of pharmacies. New barriers to obtaining contraception included an inability to obtain more than 1 month of contraception at a time and lack of coverage for over-the-counter methods. Findings about changes in the affordability of contraception postreform were mixed. Conclusion: HCR in Massachusetts changed how low-income women access contraception, presenting new opportunities and challenges for women, family planning providers, and pharmacists. The results of this project provide valuable lessons for pharmacists around the country as national HCR is implemented.