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

Enpresse, Levonest, levonor/ethi,
Myzilra, Trivora
 Active tablet (EE 30 mcg): 7 days
 Active tablet (EE 35 mcg): 9 days
 Inactive tablet (Fe only): 7 days
Tri-Levlen EE 30, 40 mcg/ levonorgestrel 0.05, 0.075, $19
(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
Norgestimate/EE, Tri-Lo-
Estarylla, Tri-Lo-Marzia, Tri-Lo- Cyclen LO
Mili, Tri-Lo-Sprintec, Tri-Vylibra
Lo, Trinessa Lo
Aranelle, Leena
Caziant, Velivet
Alyacen 7/7/7, Cyclafem 7/7/7,
Dasetta 7/7/7, Nortrel 7/7/7,
Pirmella 777
None
Kaitlib Fe, Layolis Fe,
norethindrone/EE/Fe
Aurovela 24 Fe, Blisovi 24 Fe,
Hailey 24 Fe, Junel Fe 24, Larin
24 Fe, Norethindrone/EE/Fe,
Tarina 24 Fe
KEY: EE=Ethinyl Estradiol; EV=Estradiol Valerate; Fe=Ferrous Fumarate; SD=subdermal;
TD=transdermal; LNG=levonorgestrel
Brand Estrogen/Progestin Component Cost/30days*
Ortho Tri- EE 25 mcg/ norgestimate 0.18, 0.215, 0.25 $15
mg
 Active tablet (nor 0.18): 7 days
 Active tablet (nor 0.215): 7 days
 Active tablet (nor 0.25): 7 days
 Inactive tablet: 7 days
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
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
Ortho-Novum EE 35 mcg/ norethindrone 0.5, 0.75, 1 mg $21
7/7/7
 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
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
Generess Fe EE 25 mcg/ norethindrone 0.8 mg/ Fe 75mg $86
(chewable only)
* Non-formulary  Active tablet: 24 days
 Inactive tablet: 4 days
Loestrin 24 Fe EE 20 mcg/ norethindrone 1 mg/ Fe 75 mg $90 - $269
(not available) (AWP)
 Active tablet: 24 days
 Inactive tablet: 4 days
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

drospirenone/EE, Gianvi, Jasmiel, Yaz
Loryna, Lo-Zumandimi, Nikki
None
MONOPHASIC (EXTENDED-CYCLE, 84 days)
Introvale, Jolessa,
levonorgestrel/EE, Setlakin
MULTIPHASIC (EXTENDED-CYCLE, 84 days)
Amethia, Ashlyna, Camrese,
Daysee, levonorgestrel/EE,
Simpesse
Amethia Lo, Camrese Lo,
levonorgestrel/EE
Fayosim, Rivelsa
 Inactive tablet: 4 days
EE 20 mcg/ drospirenone 3 mg $46
 Active tablet: 24 days
 Inactive tablet: 4 days
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
Seasonale EE 30 mcg/ levonorgestrel 0.15 mg $20
(not available)
Extended Cycle:
 Active tablet: 84 days
 Inactive tablet: 7 days
Seasonique EE 30, 10 mcg/ levonorgestrel 0.15 mg $54
Extended Cycle:
 Active tablet: 84 days
 Active EE only (10 mcg): 7 days
LoSeasonique EE 20, 10 mcg/ levonorgestrel 0.1 mg $47
Extended Cycle:
 Active tablet: 84 days
 Active EE only (10 mcg): 7 days
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
th
*Remove or replace by 5 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
 Initial release of 14 mcg/day per IUD
after the 1st 24 days
*Remove or replace by 3rd year
None ParaGard Copper: Non-hormonal IUD $1,061
T380A *Remove or replace on or before 10 years per IUD
None Annovera 13 Segesterone acetate/EE vaginal $2400
mcg/day l 0.15/0.013 mg/day ring per ring
Insert for 21 days, remove for 7 (lasts 1
year)
Eluryng, etonogrestre NuvaRing 15 etonogestrel 12 mcg/day vaginal $190
mis ethy est mcg/day *leave in for 3 continuous weeks, ring
then 1-week ring-free interval
Xulane Ortho Evra 35 norelgestromin 200 mcg/day TD $150/mo
(not available) mcg/day *apply weekly for 3 weeks, then patch (3
week 4 is patch-free patches)

KEY: EE=Ethinyl Estradiol; EV=Estradiol Valerate; Fe=Ferrous Fumarate; SD=subdermal;

TD=transdermal; LNG=levonorgestrel

Updated January 2020