Innovation in Medicaid to Increase Access to LARC

Jennifer E. Moore, PhD, RN, FAAN

Challenges in assuring access to long acting reversible contraception (LARC) for the Medicaid population are numerous, including limitations associated with a bundled maternity care payment system.  However, there are also innovative initiatives being tested in Medicaid managed care to overcome these barriers.  The Institute was recently invited to speak at the American Public Health Association’s annual conference, highlighting innovations in LARC access amongst the Medicaid population.  

As part of our presentation, we highlighted the work of an initiative in Washington, D.C. by a large, multi-state Medicaid managed care organization.   They developed a Care Cart containing LARC supplies, similar to a Pyxis system, that was placed in community health and school-based health centers.  As part of the Care Cart system, the health plan reimburses the pharmacy upfront to stock the cart with devices and supplies needed for insertion.  There is a low administration fee and pharmacies continue to bill the health plan for restocking of the cart.  As a result of this innovative idea, it has made it easier for providers in the D.C. area to insert same-day LARC or implants while improving adherence and access. 

The champions of this initiative credit its success on several key factors.  Support from external clinician organizations such as the American Congress of Obstetricians and Gynecologists (ACOG) and health plan leadership to promote access to LARC was paramount.  Additionally, the health plan needed to establish agreements with pharmaceutical companies to negotiate pricing and with onsite pharmacies to stock and replenish the cart.  ​