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Contraceptive Reference Chart Contraceptive Reference Chart Generics Brand Estrogen/Progestin Component Cost/30days* MONOPHASIC 21/7 regimen Afirmelle, Aubra, Aubra EQ, Alesse EE 20 mcg/ levonorgestrel 0.1 mg $15 Aviane, Delyla, Falmina, Larissia, (not available) Lessina, levonorgestrel/EE, Lutera, Orsythia, Sronyx, Vienva Apri, Cyred, Cyred EQ, Ortho-Cept EE 30 mcg/ desogestrel 0.15 mg $17 Desogestrel/EE, Emoquette, (not available), Enskyce, Isibloom, Juleber, Desogen Kalliga, Reclipsen (not available) Altavera, Ayuna, Chateal, Chateal Nordette EE 30 mcg/ levonorgestrel 0.15 mg $9 EQ, Kurvelo, Levonorgestrel/EE, (not available) Levora, Lillow, Marlissa, Portia Cryselle, Elinest, Low-Ogestrel Lo/Ovral EE 30 mcg/ norgestrel 0.3 mg $13 (not available) Aurovela 1.5/30, Hailey 1.5/30, Loestrin 1.5/30 EE 30 mcg/ norethindrone 1.5 mg $22 Junel 1.5/30, Larin 1.5/30, Microgestin 1.5/30, Norethindrone/EE 1.5/30 Aurovela Fe 1.5/30, Blisovi Fe Loestrin Fe EE 30 mcg/ norethindrone 1.5 mg/ Fe 75 mg $18 (Generic) 1.5/30, Junel Fe 1.5/30, Larin Fe 1.5/30 $261 (Brand) 1.5/30, Microgestin Fe 1.5/30, Nor/Est/FF 1.5/30 Aurovela 1/20, Junel 1/20, Larin Loestrin 1/20 EE 20 mcg/ norethindrone 1 mg $14 1/20, Microgestin 1/20, Norethindrone/EE 1/20 Aurovela Fe 1/20, Blisovi Fe 1/20, Loestrin Fe 1/20 EE 20 mcg/ norethindrone 1 mg/Fe 75 mg $21 Junel Fe 1/20, Larin Fe 1/20, Microgestin Fe 1/20, Norethindrone/EE/Fe, Tarina Fe 1/20, Tarina Fe 1/20 EQ Estarylla, Femynor, Mili, Mono- Ortho-Cyclen EE 35 mcg/ norgestimate 0.25 mg $11 (Generic) Linyah, MonoNessa, (not available) $51 (Brand) Norgestimate/EE, Previfem, Sprintec, Vylibra Balziva, Briellyn, Philith, Ovcon-35 EE 35 mcg/ norethindrone 0.4 mg $26 Vyfemla (not available) Nore/eth/fer, Wymzya Fe Femcon Fe EE 35 mcg/ norethindrone 0.4 mg/Fe 75 mg $73 - $269 (chew or swallow) (not avaiable) (AWP) Necon 0.5/35, Nortrel 0.5/35, Brevicon EE 35 mcg/ norethindrone 0.5 mg $15 Wera 0.5/35 (not available), Modicon (not available) KEY: EE=Ethinyl Estradiol; EV=Estradiol Valerate; Fe=Ferrous Fumarate; SD=subdermal; TD=transdermal; LNG=levonorgestrel Updated January 2020 Contraceptive Reference Chart Generics Brand Estrogen/Progestin Component Cost/30days* Alyacen 1/35, Cyclafem 1/35, Ortho-Novum EE 35 mcg/ norethindrone 1 mg $14 Dasetta 1/35, Nortrel 1/35, 1/35 Pirmella 1/35 Ethy eth est 1-35, Kelnor 1/35, Demulen 1/35 EE 35 mcg / ethynodiol diacetate 1 mg $22 Zovia 1/35E (not available) None Ogestrel EE 50 mcg/ norgestrel 0.5 mg $36 Ethynodiol 1-50, Kelnor 1/50 Zovia 1/50E EE 50 mcg/ ethynodiol diacetate 1 mg $25 (not available) drospirenone/EE, Ocella, Syeda, Yasmin EE 30 mcg/ drospirenone 3 mg $34 (Generic) Zarah, Zumandimine $130 (Brand) Dros/eth est tab levomefo, Safyral EE 30 mcg/ drospirenone 3 mg/ $154 generic Tydemy levomefolate calcium 0.451 mg $240 brand None Taytulla EE 20 mcg/ norethindrone 1 mg/Fe 75 mg $203 BIPHASIC Azurette, Bekyree, Mircette EE 20, 10 mcg / desogestrel 0.15 mg $31 desogestrel/EE, Kariva, Pimtrea, Simliya, Viorele Active tablet (EE 20 mcg): 21 days Inactive tablet: 2 days Active EE only (10 mcg): 5 days TRIPHASIC Tilia Fe, Tri-Legest Fe Estrostep Fe EE 20, 30, 35 mcg/ norethindrone 1 mg/ Fe $56 75 mg Active tablet (EE 20 mcg): 5 days Active tablet (EE 30 mcg): 7 days Active tablet (EE 35 mcg): 9 days Inactive tablet (Fe only): 7 days Enpresse, Levonest, levonor/ethi, Tri-Levlen EE 30, 40 mcg/ levonorgestrel 0.05, 0.075, $19 Myzilra, Trivora (not available) 0.125mg Active tablet (EE 30, lev 0.05): 6 days Active tablet (EE 40, lev 0.075): 5 days Active tablet (EE 30, lev 0.125): 10 days Inactive tablet: 7 days Norgestimate/EE, Tri Femynor, Ortho Tri- EE 35 mcg/ norgestimate 0.18, 0.215, 0.25 $11 Tri-Estaryll, Tri-Lynyah, Tri-Mili, Cyclen mg Tri-Previfem, Tri-Sprintec, Tri- (not-available) Active tablet (nor 0.18): 7 days Vylibra Active tablet (nor 0.215): 7 days Active tablet (nor 0.25): 7 days Inactive tablet: 7 days KEY: EE=Ethinyl Estradiol; EV=Estradiol Valerate; Fe=Ferrous Fumarate; SD=subdermal; TD=transdermal; LNG=levonorgestrel Updated January 2020 Contraceptive Reference Chart Generics Brand Estrogen/Progestin Component Cost/30days* Norgestimate/EE, Tri-Lo- Ortho Tri- EE 25 mcg/ norgestimate 0.18, 0.215, 0.25 $15 Estarylla, Tri-Lo-Marzia, Tri-Lo- Cyclen LO mg Mili, Tri-Lo-Sprintec, Tri-Vylibra Active tablet (nor 0.18): 7 days Lo, Trinessa Lo Active tablet (nor 0.215): 7 days Active tablet (nor 0.25): 7 days Inactive tablet: 7 days Aranelle, Leena Tri-Norinyl EE 35 mcg/ norethindrone 0.5, 1 mg $25 (not available) Active tablet (nor 0.5): 7 days Active tablet (nor 1): 9 days Active tablet (nor 0.5): 5 days Inactive tablet: 7 days Caziant, Velivet Cyclessa EE 25 mcg/ desogestrel 100, 125, 150 mcg $24 Active tablet (des 100): 7 days Active tablet (des 125): 7 days Active tablet (des 150): 7 days Inactive tablet: 7 days Alyacen 7/7/7, Cyclafem 7/7/7, Ortho-Novum EE 35 mcg/ norethindrone 0.5, 0.75, 1 mg $21 Dasetta 7/7/7, Nortrel 7/7/7, 7/7/7 Pirmella 777 Active tablet (nor 0.5): 7 days Active tablet (nor 0.75): 7 days Active tablet (nor 1): 7 days Inactive tablet: 7 days FOUR-PHASIC None Natazia EV 3, 2, 1 mg/ dienogest 2, 3 mg $378 Active estrogen only (EV 3 mg): 2 days Active tab (EV 2mg, di 2mg): 5 days Active tab (EV 2mg, di 3mg): 17 days Active estrogen only (EV 1mg): 2 days Inactive tablet: 2 days MONOPHASIC 24/4 regimen Kaitlib Fe, Layolis Fe, Generess Fe EE 25 mcg/ norethindrone 0.8 mg/ Fe 75mg $86 norethindrone/EE/Fe (chewable only) * Non-formulary Active tablet: 24 days Inactive tablet: 4 days Aurovela 24 Fe, Blisovi 24 Fe, Loestrin 24 Fe EE 20 mcg/ norethindrone 1 mg/ Fe 75 mg $90 - $269 Hailey 24 Fe, Junel Fe 24, Larin (not available) (AWP) 24 Fe, Norethindrone/EE/Fe, Active tablet: 24 days Tarina 24 Fe Inactive tablet: 4 days KEY: EE=Ethinyl Estradiol; EV=Estradiol Valerate; Fe=Ferrous Fumarate; SD=subdermal; TD=transdermal; LNG=levonorgestrel Updated January 2020 Contraceptive Reference Chart Generics Brand Estrogen/Progestin Component Cost/30days* Melodetta 24 Fe (chewable), Minastrin 24 Fe EE 20 mcg/ norethindrone 1 mg/ Fe 75 mg $134 Mibelas 24 Fe (chewable), (chewable) noreth/ethin Fe (chewable) Active tablet: 24 days Inactive tablet: 4 days Drospire/eth tab estr/lev Beyaz EE 20 mcg/ drospirenone 3 mg/ $113 (Generic) *Non-formulary levomefolate calcium 0.451 mg $200 (Brand) Active tablet: 24 days Inactive tablet: 4 days drospirenone/EE, Gianvi, Jasmiel, Yaz EE 20 mcg/ drospirenone 3 mg $46 Loryna, Lo-Zumandimi, Nikki Active tablet: 24 days Inactive tablet: 4 days None Lo Loestrin Fe EE 10 mcg/ norethindrone 1 mg/ Fe 75mg $157 *Non-formulary Active tablet: 24 days Active EE only: 2 days Inactive tablet: 2 days MONOPHASIC (EXTENDED-CYCLE, 84 days) Introvale, Jolessa, Seasonale EE 30 mcg/ levonorgestrel 0.15 mg $20 levonorgestrel/EE, Setlakin (not available) Extended Cycle: Active tablet: 84 days Inactive tablet: 7 days MULTIPHASIC (EXTENDED-CYCLE, 84 days) Amethia, Ashlyna, Camrese, Seasonique EE 30, 10 mcg/ levonorgestrel 0.15 mg $54 Daysee, levonorgestrel/EE, Simpesse Extended Cycle: Active tablet: 84 days Active EE only (10 mcg): 7 days Amethia Lo, Camrese Lo, LoSeasonique EE 20, 10 mcg/ levonorgestrel 0.1 mg $47 levonorgestrel/EE Extended Cycle: Active tablet: 84 days Active EE only (10 mcg): 7 days Fayosim, Rivelsa Quartette EE 20, 25, 30, 10 mcg/ levonorgestrel 0.15 mg $416 - $831 *Non- Extended Cycle (AWP) formulary Active tablet (EE 20 mcg): 42 days Active tablet (EE 25 mcg): 21 days Active tablet (EE 30 mcg): 21 days Active EE only (10 mcg): 7 days KEY: EE=Ethinyl Estradiol; EV=Estradiol Valerate; Fe=Ferrous Fumarate; SD=subdermal; TD=transdermal; LNG=levonorgestrel Updated January 2020 Contraceptive Reference Chart Generics Brand Estrogen/Progestin Component Cost/30days* CONTINUOUS CYCLE (no hormone-free interval) Levo-eth est Amethyst EE 20 mcg/ levonorgestrel 90 mcg $40 Take daily PROGESTIN-ONLY PILLS None Slynd drospirenone 4 mg $233 (AWP) Camila, Deblitane, Errin, Heather, Nor-QD norethindrone 0.35 mg $5 Incassia, Jencycla, Lyza, Nora- (not available), BE, norethindrone, Norlyda, Ortho-Micron Norlyroc, Sharobel, Tulana EMERGENCY CONTRACEPTIVES Aftera, Econtra EZ, Econtra OS, Plan B One- levonorgestrel 1.5 mg (1 pill) $28 levonorgestrel 1.5 mg, My Choice, Step My Way, New Day, Next Choice One Dose, Opcicon, Option 2, React, Take Action None Ella ulipristal 30 mg $58 Non-Oral Contraceptive Alternatives Generic Name Brand Name EE Progestin Route Cost/30 days* Medroxyprogesterone Depo-Provera None medroxyprogesterone acetate IM $28 acetate 150mg *every 3 months; no > 2 yrs. Medroxyprogesterone Depo-SubQ None medroxyprogesterone acetate SubQ $280 acetate Provera 104 104mg *every 3 months; no > 2 yrs. (AWP) None Nexplanon None etonogestrel 68 mg SD $1120 *remove or replace by 3rd year implant per IUD None Liletta None levonorgestrel 52 mg IUD $944 per Initial release of 18.6 mcg/day IUD then decreases to: Year 1: LNG 16.3 mcg/day Year 2: LNG 14.3 mcg/day Year 3: LNG 12.6 mcg/day *Remove or replace by 3rd year None Kyleena None levonorgestrel 19.5 mg IUD $1,144 Initial release of 17.5 mcg/day per IUD *Remove or replace by 5th year None Mirena None levonorgestrel 52 mg IUD $1,144 Initial release of 20 mcg/day per IUD *Remove or replace by 5th year KEY: EE=Ethinyl Estradiol; EV=Estradiol Valerate; Fe=Ferrous Fumarate; SD=subdermal; TD=transdermal; LNG=levonorgestrel Updated January 2020 Contraceptive Reference Chart Generic Name Brand Name EE Progestin Route Cost/30 days* None Skyla None levonorgestrel 13.5 mg IUD $952
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