Study Objective: This study examines utilization of and compliance with prescription contraception by adolescents.

Design: Retrospective cohort analysis of billing and pharmacy claims.

Setting: Ohio Medicaid fee-for-service enrollees.

Participants: Claims data of 12- to 19-year-olds identified at high risk for pregnancy by sexually related service billing or procedure code.

Main Outcome Measure: Prescription contraception use and compliance patterns were examined over a 12-month study period.

Results: During a 6-month enrollment period, 3338 females were identified at risk for pregnancy. Over one-fourth (920) became pregnant. Across the 12-month follow-up, 40% (1328) used no prescription contraception and 33% (1090) used some prescribed contraceptive. Most teens used injectable medroxyprogesterone (517) or oral contraceptive pills (492). About 20% of those using any type of prescribed contraceptive were compliant for the full year; less than 30% used a method for 3 months or less. Whites were more compliant with contraception than nonwhites. Younger age and concurrent mental health condition were also predictors of noncompliance.

Conclusions: Teens at risk for pregnancy demonstrated poor compliance with prescribed contraceptives. Billing/pharmacy claims analysis is a useful tool for identifying teens at risk for pregnancy in order to target and evaluate interventions or to benchmark care provided to adolescents.