Stock a Broad Range of Methods (Best Practice 1)

Stock a Broad Range of Methods (Best Practice 1)

Stock a Broad Range of Contraceptive Methods Contraceptive Access Change Package Best Practice 1 Last Reviewed April 2019 1 Introduction to the Contraceptive Access Change Package Best Practice Recommendations

1. Stock all methods 2. Utilize patientcentered counseling 3. Offer same-visit access 4. Reduce cost as a Link: https:// 2 Contraceptive Access Change Package: Best Practice 1 Stock a broad range of contraceptive

methods including all provider-dependent FDA-approved contraceptive methods 3 Meeting Objectives By the end of today, you should be able to: Describe the importance of stocking a broad range of contraceptive methods, including provider-dependent methods Describe common challenges related to stocking a broad range of contraceptive

methods Describe at least one strategy to improve site-level stocking practices 4 Rationale for Stocking a Broad Range of Methods Patients who obtain their method of choice are more likely to use it correctly, and be more satisfied Many patients do not return for follow-up visits

Stocking all methods is necessary for providing methods to patients during the same visit they initially request it 5 Defining a Broad Range of FDAApproved Methods At a minimum, at least one type of all provider- dependent methods should be stocked on site Contraceptive Services or referral for methods

patch FDA-approved include: sterilization (vasectomy, abdominal, laparoscopic, hysteroscopic) Hormonal implant Levonorgestrel intrauterine device (LNG IUD)

Copper intrauterine device (Cu IUD) Hormonal injection Oral contraceptive Vaginal ring Diaphragm and cervical cap Sponge Condoms (male and female)

Spermicide 6 Contraceptive Access Assessment 7 Discussion of Challenges Related to Stocking Methods What methods are not stocked

always/almost always? What are the challenges related to stocking these methods? Hormonal IUD Copper IUD Contraceptive implant Depo Pill, patch, ring 8 Overview of Stocking Strategies Obtain lower-cost supplies

Optimize inventory system Stock and inform patients about emergency contraception (EC), including copper IUD as EC Ensure staff with patient contact are: aware of and trained in current recommendations available to provide the broad range of methods 9 Strategies for Obtaining Affordable

Supplies Participating in 340B program Stocking Liletta Purchasing in bulk Utilizing 90-day net terms, other payment options Centralized ordering Patient assistance programs (e.g., ARCH) Additional grant funding Others? 10 Insurance Coverage of Contraceptive

Methods Preventive services requirement: most plans must cover without costsharing: Items or services that have an A or B rating from the USPSTF Immunizations recommended by CDCs Advisory Committee on Immunization Practices HRSA-supported preventive care and screenings for infants, kids, and adolescents Preventive services for women determined by HRSA All FDA-approved contraceptive methods, 11

Insurance Claim Denials Respond immediately with appeal Track and monitor reasons for denial Watch adjustments carefully Prevent future denials 12 Strategies for

Optimizing the Inventory System Forecast the range and number of each method needed Conduct a regular (e.g., monthly) inventory of stock Monitor dispensing amounts and adjust ordering accordingly Utilize a buy and bill approach (for procurement of methods stocked on site) 13 Potential Sources

of Information for Forecasting Annual contraceptive patient Patien t population Historical demand data Annual provision at other sites Provid er Number of providers trained in certain methods

Policy around same-day placement Financ e Patient health care coverage Funding available for procurement apted from: http://larcprogram.ucsf.edu/forecasting 14 Forecasting Resources LARC Modeling Tool (CAI)

http://www.caiglobal.co/larc/ http ://www.who.int/rhem/supplyc hain/pockguidmanacont/en 15 Buy and Bill Medical Benefit Provider bills insurance for method and service Buy and bill Pharmacy Benefit Provider bills for service

Pharmacy bills for method 16 IUDs & Implants: A Guide to Reimbursement (UCSF) Link: http://larcprogram.ucsf.edu 17 Stocking Copper IUD as According to

EC Option ACOG 2015 EC Guidelines, Insertion of a copper IUD is the most effective method of emergency contraception (EC). Emergency contraception. ACOG 2015

Link: https://www.fpntc.org/resources/quick-start-algorithm 18 Contraceptive Access Assessment 19 LARC Insertion Trainings LARC Link is an online tool for clinical

providers who wish to find LARC placement trainings and resources Link: http://www.ctcfp.org/larc-link/ 20 Case Scenario You find that you often run out of Nexplanon. In the past you ordered 3-6 devices, per month. Demand has

increased, however, and you are experiencing stock-outs every couple of months. Due to the high cost of the device, the organizational policy is to order only 3 at a time. What do you do? 21 Success Story: Stocking Liletta (Cameron County, TX) Large percentage of patients below FPL Began stocking Liletta in March 2016 Then able to insert Liletta during the same

visit initially requested by patient because it was routinely stocked Continue to monitor stock to ensure it meets demand Key point: As a lower-cost option ($50 at 340B pricing), stocking Liletta can meet unmet patient demands for IUD 22 Success Story: Stocking Nexplanon (Southern Nevada) Patients are interested in and asking for Nexplanon

Began stocking Nexplanon in 2016 Developed policy, arranged for training, ordered devices Prepared insertion kits to facilitate insertion process Key point: Many patients, including adolescents, are interested in the contraceptive implant. Stocking it is important for ensuring access. 23 What other questions do you

have? What other issues would you like to discuss? 24 Thank you! Contact: [email protected] 25

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