# Contraceptive Prescribing and Dispensing After the Defense Health Agency’s Policy Change

## TL;DR

A policy change by the Defense Health Agency increased access to some contraceptives for active-duty women, but full implementation remains a challenge.

## Contribution

This study evaluates the real-world impact of a policy on contraceptive access and prescribing patterns among active-duty servicewomen.

## Key findings

- Extended-supply prescriptions for short-acting reversible contraceptives increased significantly after the policy change.
- The overall proportion of active-duty servicewomen receiving extended contraceptive supply did not increase significantly.
- Prescriber provision of extended supply showed modest increases but no sustained trend.

## Abstract

Was the release of Defense Health Agency Procedural Instruction (DHA-PI) 6200.02, which aimed to increase access to contraceptives among beneficiaries, associated with changes in contraceptive prescribing and dispensing patterns among active-duty servicewomen (ADSW)?

In this cohort study of 429 194 ADSW, statistically significant increases were observed in extended-supply prescriptions of short-acting reversible contraceptives. However, the proportion of eligible ADSW receiving extended supply declined, and no statistically significant changes were seen in the number of prescribers providing extended supply.

These findings suggest partial uptake of the DHA-PI 6200.02 policy across the Military Health System, with opportunities for improvement with consistent implementation of extended contraceptive supply.

This cohort study evaluates changes in contraceptive prescribing and dispensing practices associated with Defense Health Agency (DHA) Procedural Instruction 6200.02, focusing on extended day supply of short-acting reversible contraception, long-acting reversible contraception, and permanent contraception.

The Defense Health Agency Procedural Instruction (DHA-PI) 6200.02, introduced in May 2019, aimed to improve contraception access and knowledge among eligible beneficiaries. However, the policy’s association with contraception prescribing and dispensing practices has not been fully evaluated.

To evaluate changes in contraceptive prescribing and dispensing practices associated with DHA-PI 6200.02, focusing on extended day supply of long-acting reversible contraception (LARC), short-acting reversible contraception (SARC), and permanent contraception.

This retrospective cohort study was conducted utilizing interrupted time-series analysis to examine changes in contraception care practices before and after policy implementation. The study period was between January 1, 2016, and September 30, 2022. Participants were active-duty servicewomen (ADSW) aged 18 to 55 years, with an assigned sex of female in medical records who were enrolled in TRICARE.

The implementation of the DHA-PI 6200.02 policy in May 2019.

The primary outcomes included rates of extended contraceptive supply and utilization of LARC, SARC, and permanent contraception. Five performance measures were employed to assess the associations between DHA-PI 6200.02 and changes in contraceptive supply. Segmented regression models were unadjusted and used to estimate level and trend changes in monthly MOPs.

Among 429 194 ADSWs (mean [SD] age 24.5 [7.0] years; 148 104 [34.5%] Army, 101 299 [32.6%] Navy, 115 288 [26.86%] Air Force, and 35 352 [8.24%] Marine Corps), the proportion of SARC users receiving extended supply increased from 1.1% prepolicy to 5.3% postpolicy. Extended SARC use increased from 16.3% (95% CI, 16.0%-16.7%) at baseline to 19.7% (95% CI, 17.9%-21.6%) at the end of follow-up, and dispensed extended SARC rose from 8.2% (95% CI, 7.9%-8.5%) to 9.3% (95% CI, 7.4%-11.1%), both reflecting significant post-policy upward trends. The overall proportion of ADSW with any extended contraceptive supply showed no meaningful change and declined significantly in trend. Prescriber provision of extended supply rose modestly without sustained trend change, and among contraceptive users extended supply increased but without significant policy-related effects.

In this cohort study of ADSWs, DHA-PI 6200.02 was associated with increased access to extended day supply for SARC but no corresponding increases were observed in overall extended contraceptive supply across all methods (SARC, LARC placement, and permanent contraception). These findings underscore challenges in policy uptake and highlight the need for enhanced efforts to ensure comprehensive implementation of DHA-PI 6200.02.