British Columbia’s decision last year to make contraception free led to a spike in the number of women choosing long-acting options, such as intrauterine devices, that are better than the pill at preventing unwanted pregnancies, new data show.
Researchers at the University of British Columbia have been tracking how the policy, which kicked in April 1, 2023, is influencing the number and type of birth-control products dispensed across the province.
They noted a significant shift to IUDs, implants and other types of long-acting birth control as soon as those products, which can cost as much as $400 upfront, became 100 per cent publicly funded.
“It’s a really substantial change, more than we really thought we might find and more than we generally see for cost-sharing policy changes in other kinds of clinical areas,” said Laura Schummers, a reproductive epidemiologist and assistant professor in the department of pharmaceutical sciences at UBC.
She and her UBC colleague, Michael Law, a Canada Research Chair in access to medicines, unveiled the data at a research seminar on Tuesday.
Their findings could have implications for the rest of Canada. Birth control is one of two categories of prescriptions drugs, alongside diabetes treatment, for which the federal government promised to provide universal public coverage in the first phase of a national pharmacare plan.
However, the pharmacare legislation that passed in October is only a framework. The federal Liberals still have to negotiate bilateral agreements with individual provinces to roll out coverage. Some, including Alberta and Quebec, have already said they intend to opt out.
Pharmacare’s fate is also tied to the fortunes of Prime Minister Justin Trudeau’s government, which is trailing in the polls and which suffered a severe blow this week after Chrystia Freeland quit as finance minister and deputy prime minister.
Dr. Law told the seminar that B.C.’s experience could be a road map for other provinces if federally funded contraception coverage doesn’t pan out. Manitoba has already taken that step, making birth control free as of Oct. 1.
“B.C. did this on on its own and put it into place,” he said. “And what we expect to find based on a lot of the simulation work is that this will be a cost-saving policy.”
Drs. Schummers and Law, and their colleagues, mined a national prescription database to compare birth-control dispensing before and after contraception became free in B.C. They started by analyzing the trends prior to April 1, 2023, to project what the dispensing patterns would have been had the province not changed its policy. Then, they compared those predictions to what actually happened.
The team found that by June, 2024, approximately 80,200 women in B.C. were using long-acting reversible contraception such as IUDs and implants – 11,400 more than would have been the case had the provincial government not enacted a free contraception policy.
The number of women using any form of contraception rose as well. Approximately 159,300 B.C. women were taking birth control of any kind by June – 10 per cent more than would have been the case if they had to pay out of pocket or through private insurance. (Those figures don’t include people, such as social-assistance recipients, who already had full public coverage of prescription drugs, including birth control, before the policy change.)
Unsurprisingly, providing full public coverage of birth control caused a drop in the share of women paying out of pocket or relying on private insurance for birth control.
Had the old policy remained in place, 37 per cent of spending on contraceptives in the province would have come from women’s pockets by June, the researchers projected. Instead, 13 per cent did. The fact that some birth-control users continued to pay a portion of the costs themselves could be because of B.C. not covering every type of contraception on the market.
The cost of the province’s program is $119 million over the first three years. Dr. Schummers said the uptake data so far are in line with cost-effectiveness modelling that predicted public coverage of birth control would result in savings of $27 million annually for the health-care system starting in the fourth year of the program. Researchers plan to keep tracking the program to see if those savings pan out.
“It’s important for governments to recognize that this is a good fiscal decision for disposition of health dollars in every province, in every case,” said Wendy Norman, a UBC professor and Canada Research Chair in family planning innovation who led the contraception cost-effectiveness study that informed B.C.’s policy.
“It will always cost the government more to manage unintended pregnancies than it will to make contraception free.”
