Long-acting reversible contraceptives (LARC) are extremely safe and effective. Unlike other methods, they work for three to twelve years and require little work once placed. Despite the endorsement by many medical organizations, there are challenges to making LARC devices available to adolescents. Pediatric providers often lack adequate training on how to provide comprehensive contraceptive counseling, perform LARC insertions, and manage post-insertion challenges. Pediatric health systems are often unprepared to provide confidential services, accommodate the longer visit time needed for LARC counseling and insertion, and manage teen-parent dyads. Insurance companies are continuing to find ways around paying for LARC methods. Moreover, adolescents have different knowledge, attitudes, and beliefs about LARC methods and are developmentally different from adult women, making their contraceptive needs unique. The Children’s Hospital of Philadelphia has developed innovative solutions to meet the contraceptive needs of adolescents. These include hiring an obstetrician-gynecologist as medical director of gynecology services who has opened an adolescent LARC clinic, training pediatric providers to insert devices, developing a website for parents and adolescents to improve reproductive health education, and working with Medicaid payers to create a pilot device dispensing machine program that allows same-day LARC insertions. The medical director has written policy briefs and partnered with community-based reproductive health advocacy organizations and city and state policymakers to advocate for changes in hospital contracts and increased reimbursements from payers. We highlight our experience supporting adolescent LARC use, which has required a different approach than adult care, along with changes in health system and payer policies.