The transdermal contraceptive patch, available under brand names like Xulane and Twirla, is a small adhesive square that delivers hormones through the skin to prevent pregnancy. This method offers a convenient, weekly alternative to the daily pill, but its cost can fluctuate significantly. The final price a patient pays is not fixed, varying widely based on insurance status, the specific type of coverage, the pharmacy chosen, and whether cost-saving measures are utilized. Understanding these variables is the first step in determining the true out-of-pocket expense for this prescription medication.
The Baseline Cost: Paying Without Coverage
The retail price for the contraceptive patch when paying entirely out-of-pocket, often called the cash price, can be substantial. For a single cycle, which typically includes three patches to last one month, the price can range from approximately $150 to over $270 before any discounts are applied. This wide range reflects differences in the Manufacturer Suggested Retail Price (MSRP) for the brand-name versions and the retail markups at various pharmacies. Xulane, for example, has been cited with an average retail price of around $273 for a box of three patches. The newer brand-name patch, Twirla, may also fall within a similar high price bracket. Patients without insurance are paying the full cost, which also includes the price of the required doctor’s visit, which can cost an additional $35–$250 without coverage. This high baseline cost makes the use of coupons or assistance programs nearly essential for the uninsured.
How Insurance Affects the Final Price
For most people with private health insurance, the cost of the transdermal patch is often zero due to mandates established by the Affordable Care Act (ACA). The ACA requires most private plans to cover all Food and Drug Administration (FDA)-approved contraceptive methods for women without any cost-sharing, such as copayments, coinsurance, or deductibles. This means that if your plan is compliant, you should receive the patch at no charge, provided it is one of the methods your plan covers.
However, several exceptions exist that can cause the price to rise above zero. Plans that were “grandfathered” in when the ACA was signed into law may not be required to follow the no-cost-sharing rule for preventive services, though these plans are becoming less common. Furthermore, employers with religious or moral objections can qualify for exemptions, which allows their health plans to exclude contraceptive coverage entirely. In these cases, the full retail cost or a negotiated rate must be paid by the patient.
Even with a compliant insurance plan, the final price can depend on the specific brand prescribed. While plans must cover a range of options, they may only cover the generic or a specific brand at no cost, requiring a patient to pay a full copay for a non-preferred brand like Twirla or Xulane. This difference is managed through a plan’s formulary, and a patient may need a prior authorization from their doctor to get a non-preferred patch covered with no cost-sharing if a medical necessity is proven. Public programs like Medicaid generally cover the patch, often at no cost to the patient, as they are designed to eliminate financial barriers to care.
Methods for Lowering the Cost
Patients can significantly reduce their out-of-pocket expenses for the contraceptive patch by utilizing various cost-saving strategies regardless of their insurance status. One of the most effective methods involves using prescription discount cards, such as SingleCare or GoodRx, which can lower the cash price substantially. For example, the cost of a three-patch box of Xulane can be reduced significantly with a common discount card.
For individuals who are uninsured or underinsured, patient assistance programs offered by the drug manufacturers may provide the medication for free or at a reduced cost. These programs typically have income and insurance eligibility requirements that must be met to qualify for the benefit. Additionally, many pharmaceutical companies offer manufacturer coupons for specific brand-name patches, though these are typically only available to those with private insurance and cannot be used by patients with government-funded insurance like Medicare or Medicaid.
Exploring options at community health centers and family planning clinics, such as Planned Parenthood, can also lead to free or low-cost access based on a sliding scale determined by income. Finally, patients should ask their pharmacy if purchasing a three-month supply instead of a single month offers a bulk discount. Choosing an available generic version, if medically appropriate, is another straightforward way to lower the cost compared to a higher-priced brand name patch.