Women On Meds That Can Cause Birth Defects Still Skip Birth Control Pills

Despite the risks, women who take medications that can cause birth defects don’t always take their contraceptive pills, a new study suggests.

The study, in the American Journal of Medicine, is the latest addition to a growing genre of medical research based on the giant databases of drug claims assembled by pharmacy-benefit managers. In this case, Medco Health Solutions Inc. looked at 26,136 women among its enrollees who were between the ages of 18 to 44 and were prescribed both an oral contraceptive and a medication that poses a risk to a fetus. Those included statins, sedatives, cancer drugs and anti-acne medications.

Of those women, around 60% appeared to take their contraceptives very reliably, measured as filling prescriptions often enough to have the pills on hand at least 95% of the time. About 22% were moderately adherent, with their contraceptive available 80% to 94% of the time, and another 19% or so appeared to have the pills less than 80% of the time. Those rates barely differed from those for women who weren’t taking drugs that posed fetal dangers.

The researchers said certain groups of women were less adherent to their contraceptive regimens, including those who were taking a large number of different prescription drugs, members of ethnic minorities and those who reported lower levels of education. They suggested that some patients aren’t counseled effectively by doctors or pharmacists, and may not understand information they receive from medication labels and other sources about possible birth-defect risks posed by their drugs.

“This is one of those discussions that can be awkward for patients as well as physicians and pharmacists,” Amy Steinkellner, the study’s lead author and national practice leader for women’s health and family medicine at Medco, tells the Health Blog.

PBMs are getting increasingly aggressive about research and services that push medication compliance, which isn’t a big surprise because they make money partly based on prescriptions being filled. Though patients’ failure to take drugs generally is seen as a significant public-health issue, some ethics researchers have questioned whether PBM and health-insurer enrollees should get a chance to give specific consent before their information is used for research and other purposes. Medco said it analyzed data without names attached and got permission from its clients, which are mostly employers, to use the anonymous information.
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