Illinois Medicaid to Provide Increased Access to Contraception.
Posted by on August 21, 2014 - 9:41am

Medicaid patients in Illinois (our home state!) could gain increased access to contraception under policy changes proposed August 18 by the Department of Healthcare and Family Services, according to the Chicago Tribune.  Health care providers would receive more money for providing vasectomies to men and birth control to women under the proposal, which also includes a possible new referral requirement for Roman Catholic providers and others that object to contraception.

The department expects to implement most of the proposed changes this fall, but department Director Julie Hamos said Medicaid will immediately start paying more toward the cost of long-term contraception at walk-in providers such as Planned Parenthood clinics.

Hamos said her department proposed the changes in part to address the recent Supreme Court decision that allowed some companies to exclude contraceptives from their employees' insurance coverage on religious grounds. Oklahoma-based arts-and-crafts retailer Hobby Lobby, owned by evangelical Christians, sued over a requirement under the Affordable Care Act to cover contraceptives.

The court's decision was of "extreme concern" to Gov. Pat Quinn and state health officials, Hamos said. The new proposal affects residents covered under Medicaid, not by employers, but Hamos said the court's decision brought new focus to the issue, spurring the department to announce the proposal quickly.

"It is an opportune time when women across the country are paying attention … that's a time that we can really use that attention to focus on what's available to them through Medicaid," Hamos said. She noted that the change could help low-income women who shift between Medicaid and employer coverage as their employment situations change. Unplanned pregnancies constitute a major cost among the approximately 1 million women of childbearing age enrolled in Medicaid in Illinois, Hamos said. About 3 million Illinoisans in all are enrolled, and the number is set to expand under the Affordable Care Act, commonly known as Obamacare.

Expanded family planning has succeeded at saving money in other states, Hamos said, citing a Colorado initiative that she said cut teen birthrates by 40 percent from 2009 through 2013, reduced abortions and saved the state $42.5 million in 2010.

The Illinois proposal aims to coax more health care providers into expanding family planning services by increasing their reimbursement rates starting Oct. 1. Payments for vasectomies and intrauterine devices would be doubled. Hamos said the department is working with companies that manufacture IUDs to ensure they're on health care providers' shelves when needed.

This Chicago Tribune story was produced in partnership with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Microchip contraceptive with on/off switch?
Posted by on July 11, 2014 - 9:30am
Women may soon bid farewell to birth control pills and welcome a new type of contraception in the form of microchip implants. An MIT startup backed by the Bill Gates Foundation plans to start pre-clinical testing for the birth control chip next year and pave the way for a possible market debut in 2018.

The fingernail-size microchip implant holds enough 30-microgram daily doses of levonorgestrel—a hormone already used in several contraceptives—to last for 16 years. Women who received the implant under the skin of buttocks, upper arm or abdomen would also get a remote control that allows them to halt or restart the implant whenever they like, according to MIT Technology Review.

MicroCHIPS, the MIT startup behind the birth control implant, developed a clever design for a titanium and platinum seal that temporarily melts when an internal battery sends an electric charge running through the seal. That lasts just long enough for the melted seal to release the daily dose of levonorgestrel from the microchip reservoirs.

The microchip technology's latest mission first came about when Bill Gates visited the MIT lab of Robert Langer and challenged researchers to come up with a birth control method that women could control themselves and would also last for many years. Langer, an MIT professor who already holds 1,050 patents worldwide, thought of using the controlled release microchip technology that he and his colleagues had developed in the 1990s.

MicroCHIPS had previously demonstrated how the microchip technology could release daily doses of an osteoporosis drug during human clinical trials detailed in the 16 Feb 2012 online edition of the journal Science Translational Medicine. The new application for the microchips—each measuring 20 x 20 x 7 millimeters—could potentially revolutionize the level of control women have over their birth control technologies.

The biggest difference that the MicroCHIPS technology brings comes from giving women control over starting and stopping birth control regimens that can otherwise work for years without requiring regular attention. By comparison, existing contraceptive implants require a trip to the local clinic or hospital for removal if a woman wants to stop using the implant.

Any device offering wireless control for its users also runs the risk of being hacked. But Robert Farra, president and CEO of MicroCHIPS, told BBC News that their technology included secure encryption to prevent outsiders from blocking or reprogramming the implants wirelessly. As an added precaution, the remote control can only communicate with the microchip implant across a distance equivalent to skin contact.

Source:  IEEE Spectrum  By Jeremy Hsu

Posted

 

The Right to Contraception Coverage
Posted by on July 1, 2014 - 1:03pm

Yesterday, in a 5-4 decision, the Supreme Court ruled that “requiring family-owned corporations to pay for insurance coverage for contraception under the Affordable Care Act violated a federal law protecting religious freedom.” Justice Samuel A. Alito Jr. conceded that the government does have a “compelling interest in making sure women have access to contraception,” but that there are ways of providing that access without “violating the companies’ religious rights.”

Justice Ginsburg’s dissent put into words what many onlookers felt. Justice Ginsburg stated that requiring contraception coverage is vital to women’s health and reproductive freedom. Furthermore, Justice Ginsburg stated this may invite “for-profit entities to seek religious-based exemptions from regulations they deem offensive to their faiths,” including some medical procedures and drugs, vaccinations, and even blood transfusions—procedures which certain religions denounce. While there is no evidence yet to support this claim that corporations will begin splitting hairs over other medical procedures, it does raise important questions about where the line is drawn between business and religion.

Those who disagree with the Supreme Court decision state that requiring all insurance plans to include coverage for contraception improves not only public health, but also ensures that “women have equal access to health care services.” Therefore, this blow was particularly shocking. If other family-owned corporations follow this ruling, the cost for contraception coverage will likely become a barrier for many women. IUD’s, for instance, can coast more than $1,000 once medical exams, insertion, and follow-up visits are added—and it is likely that this may cost too much for some women to pay without insurance coverage.

While the full repercussions of this decision are not yet clear, it is important to develop protective measures that defend women’s healthcare and their access to a range of contraception options.

Source: The New York Times

Stroke and birth control pills
Posted by on December 18, 2012 - 10:30am

The relative risks of thrombotic stroke and myocardial infarction (MI) are higher among users of hormonal contraception, although absolute risks remain low, a Danish study conducted at Copenhagen University  showed.

Use of oral contraceptives combining low-to-moderate doses of ethinyl estradiol and various progestins was associated with up to 2.3 times the risks of thrombotic stroke or MI compared with non-use.The type of progestin in the pill had little effect on the risks, the researchers reported in the June 14 issue of the New England Journal of Medicine.

To put the risk in perspective, they estimated that among 10,000 women taking a pill combining desogestrel with ethinyl estradiol at a dose of 20 μg for 1 year, two will have arterial thrombosis and seven will have venous thrombosis.

"Although venous thrombosis is three to four times as frequent as arterial thrombosis among young women, the latter is associated with higher mortality and more serious consequences for the survivors," they wrote. "Therefore, these figures should be taken into account when prescribing hormonal contraception."

Several previous studies have examined the relationship between hormonal contraceptive use and the risk of venous thromboembolism. But fewer have looked at arterial complications like thrombotic stroke and MI, and the results have been mixed.

In an accompanying editorial, Diana Petitti, MD, MPH, of Arizona State University in Tempe, said that the absolute increases in the risks of thrombotic stroke and MI observed in the study were small."None of the hormonal contraceptives studied ... were associated with an excess risk of stroke that was unacceptable, considering their contraceptive and noncontraceptive benefits," she wrote.

And, she added, evidence from previous studies "shows that the small risk could be minimized and perhaps eliminated by abstinence from smoking and by checking blood pressure, with avoidance of hormonal contraceptive use if blood pressure is raised."

The researchers acknowledged the study was limited by possible diagnostic misclassification, the potential for a time lag between the date of prescription and when the contraceptives were started, the lack of information on body mass index, and the incomplete information on smoking status.

Source reference:
Lidegaard Ø, et al "Thrombotic stroke and myocardial infarction with hormonal contraception" N Engl J Med 2012; 366: 2257-2566.

 

 

Safety concerns raised on birth control pills containing drospirenone
Posted by on September 30, 2011 - 6:02am

[09-26-2011] The U.S. Food and Drug Administration (FDA) is informing the public that it has not yet reached a conclusion, but remains concerned, about the potential increased risk of blood clots with the use of drospirenone-containing birth control pills. FDA has completed its review of the two 2011 studies that evaluated the risk of blood clots for women who use drospirenone-containing birth control pills, previously mentioned in FDA's Drug Safety Communication issued on May 31, 2011. FDA is continuing its review of a separate FDA-funded study that evaluated the risk of blood clots in users of several different hormonal birth control products (contraceptives). Preliminary results of the FDA-funded study suggest an approximately 1.5-fold increase in the risk of blood clots for women who use drospirenone-containing birth control pills compared to users of other hormonal contraceptives.

"It is unknown at this time whether the reported VTE risk applies to all drospirenone-containing products," the FDA indicated.    Drospirenone-containing products with the higher estrogen dose include Yasmin, Zarah, Syeda, Safyral, and Ocella.   Those with the lower amount of estrogen include Yaz, Loryna, Gianvi, and Beyaz.

Given the conflicting nature of the findings from six published studies evaluating this risk, as well as the preliminary data from the FDA-funded study, FDA has scheduled a joint meeting of the Reproductive Health Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee on December 8, 2011 to discuss the risks and benefits and specifically the risk of blood clots of drospirenone-containing birth control pills.

In the meantime, the agency advised health professionals to inform women taking drospirenone-containing products of the potential clotting risk.  Smoking, being overweight, and having a family history of clotting disorders are all risk factors for VTE that should be discussed with patients, the agency noted.

To read full report click HERE .

 

 

IUDs and implants effective reversible contraceptive methods
Posted by on July 19, 2011 - 7:28am

Sample IUD

Long-acting reversible contraceptive ( LARC ) methods—namely intrauterine devices ( IUDs ) and implants—are the most effective forms of reversible contraception available and are safe for use by almost all reproductive-age women, according to a Practice Bulletin released  by The American College of Obstetricians and Gynecologists ( The College ). The new recommendations offer guidance to ob-gyns in selecting appropriate candidates for LARCs and managing clinical issues that may arise with their use.

"LARC methods are the best tool we have to fight against unintended pregnancies, which currently account for 49% of US pregnancies each year," said Eve Espey, MD, MPH, who helped develop the new Practice Bulletin. "The major advantage is that after insertion, LARCs work without having to do anything else. There's no maintenance required."

More than half of women who have an unplanned pregnancy were using contraception. The majority of unintended pregnancies among contraceptive users occur because of inconsistent or incorrect contraceptive use. LARCs have the highest continuation rates of all reversible contraceptives, a key factor in contraceptive success.

IUDs and contraceptive implants must be inserted in a doctor's office. Two types of IUDs—small, T-shaped devices that are inserted into the uterus—are available. The copper IUD, which effectively prevents pregnancy for 10 years, releases a small amount of copper into the uterus, preventing fertilization. In addition, copper interferes with the sperm's ability to move through the uterus and into the fallopian tubes. The device can also be used for emergency contraception when inserted within five days of unprotected sex.

Women using the copper IUD will continue to ovulate, and menstrual bleeding and cramping may increase at first. Though data suggest that these symptoms lessen over time, heavy menstrual bleeding and pain during menstruation ( dysmenorrhea ) are main causes of discontinuation among long-term copper IUD users. Women considering IUDs should be informed of this adverse effect beforehand.

The hormonal IUD releases progestin into the uterus that thickens cervical mucus and thins the uterine lining. It may also make the sperm less active, decreasing the ability of egg and sperm to remain viable in the fallopian tube. The hormonal IUD may make menstrual cycles lighter and is also FDA-approved for the treatment of heavy bleeding. The hormonal IUD prevents pregnancy for five years.

Contraceptive implant

The contraceptive implant is a matchstick-sized rod that is inserted under the skin of the upper arm and allows the controlled release of an ovulation-suppressing hormone for up to three years. It is the most effective method of reversible contraception available with a pregnancy rate of 0.05%.

Despite the many benefits of LARC methods, the majority of women in the US who use birth control choose other methods. Fewer than 6% of women in the US used IUDs between 2006 and 2008. According to The College, lack of knowledge about LARCs and cost concerns may be to blame. "Women need to know that today's IUDs are much improved from earlier versions, and complications are extremely rare. IUDs are not abortifacients—they work before pregnancy is established—and are safe for the majority of women, including adolescents and women who have never had children. And while upfront costs may be higher, LARCs are much more cost-effective than other contraceptive methods in the long run," Dr. Espey said.

According to a December 2009 Committee Opinion released by The College, LARCs should be offered as first-line contraceptive methods and encouraged as options for most women. "The benefits of IUDs and the contraceptive implant in preventing unplanned pregnancy could be profound with widespread adoption of these methods, and ob-gyns are in a great position to effect change," Dr. Espey said.

Practice Bulletin #121 "Long-Acting Reversible Contraception: Implants and Intrauterine Devices" is published in the July 2011 issue of Obstetrics & Gynecology.