When Annovera isn't available, you still have options

Annovera is a game-changer for many patients — a single reusable vaginal ring that provides birth control for an entire year. But if you can't find it at your pharmacy, can't afford the cash price, or your insurance won't cover it, you need a backup plan.

The good news: there are several effective alternatives that work in similar ways. Let's walk through what Annovera is, how it works, and which alternatives might be right for you.

What is Annovera and how does it work?

Annovera (segesterone acetate and ethinyl estradiol vaginal system) is a flexible silicone vaginal ring that prevents pregnancy by releasing two hormones — a progestin (segesterone acetate, 0.15 mg/day) and an estrogen (ethinyl estradiol, 0.013 mg/day).

These hormones work together to:

• Suppress ovulation (prevent your ovaries from releasing eggs)
• Thicken cervical mucus to block sperm
• Thin the uterine lining to prevent implantation

You insert the ring for 21 days, remove it for 7 days (when you get your period), and then reinsert the same ring. One ring lasts for 13 cycles — a full year of birth control.

For a deeper dive, see our guide: What is Annovera? Uses, dosage, and what you need to know.

Why you might need an alternative

There are several common reasons patients look for Annovera alternatives:

• Availability: Many pharmacies don't stock Annovera due to its high cost and niche demand.
• Cost: Without insurance, Annovera costs $2,670–$3,275. Even with insurance, copays can be significant.
• Insurance restrictions: Some plans require prior authorization or step therapy before covering Annovera.
• BMI limitation: Annovera hasn't been adequately studied in patients with a BMI over 29 kg/m².

Alternative 1: NuvaRing (etonogestrel/ethinyl estradiol)

NuvaRing is the most direct alternative to Annovera. It's also a vaginal ring that you insert for 21 days and remove for 7 days. The key differences:

• Duration: NuvaRing lasts only one month. You need a new ring every cycle.
• Hormones: NuvaRing uses etonogestrel (a different progestin) and ethinyl estradiol.
• Cost: Generic NuvaRing (Eluryng) is available, bringing costs down significantly to around $30–$80/month with coupons.
• Availability: Much more widely stocked at pharmacies than Annovera.

Best for: Patients who like the vaginal ring method but need something easier to find and more affordable.

Alternative 2: Eluryng (generic NuvaRing)

Eluryng is the generic version of NuvaRing, containing the same hormones (etonogestrel/ethinyl estradiol) at the same doses. It works identically to NuvaRing.

• Cost: Typically $0–$50/month with insurance; $30–$90/month with discount cards.
• Availability: Widely available at most pharmacies.
• How to use: Same 21-day in/7-day out cycle as NuvaRing and Annovera, but requires a new ring each month.

Best for: Budget-conscious patients who want a vaginal ring contraceptive without the high Annovera price tag.

Alternative 3: Xulane (norelgestromin/ethinyl estradiol patch)

Xulane is a contraceptive patch you apply to your skin once a week for three weeks, followed by one patch-free week. It's not a vaginal ring, but it offers similar "set it and forget it" convenience.

• How it works: Releases hormones through the skin to suppress ovulation, similar to how Annovera works vaginally.
• Cost: Around $150–$250/month without insurance; often $0–$30 with insurance.
• Availability: Widely available at pharmacies.
• Consideration: May be less effective in patients weighing over 198 lbs (90 kg).

Best for: Patients who prefer not to use a vaginal product but still want a non-daily contraceptive.

Alternative 4: Twirla (levonorgestrel/ethinyl estradiol patch)

Twirla is a newer contraceptive patch that delivers a lower dose of hormones than Xulane. It's applied weekly, similar to Xulane.

• Hormones: Uses levonorgestrel (a different progestin) and a lower dose of ethinyl estradiol.
• Cost: Around $200–$300/month without insurance.
• Consideration: Not recommended for patients with a BMI of 30 or higher.

Best for: Patients who want a lower-hormone patch option and have a BMI under 30.

Quick comparison table

Here's how these alternatives stack up against Annovera:

• Annovera: Vaginal ring, lasts 1 year, $2,670–$3,275 cash price, no generic
• NuvaRing: Vaginal ring, lasts 1 month, $150–$200/month cash, generic available (Eluryng)
• Eluryng: Vaginal ring, lasts 1 month, $30–$90/month cash, generic
• Xulane: Skin patch, weekly, $150–$250/month cash, generic of Ortho Evra
• Twirla: Skin patch, weekly, $200–$300/month cash, brand only

Talk to your doctor

Switching contraceptives is a medical decision. Talk with your doctor or OB/GYN about which alternative is best for your body, your lifestyle, and your budget. If you haven't given up on Annovera, check our guide on how to find Annovera in stock near you — it may still be available at a pharmacy nearby.

Final thoughts

Annovera's year-long convenience is hard to beat, but it's not the only option. NuvaRing, Eluryng, Xulane, and Twirla all offer effective, non-daily birth control that can fill the gap while you wait for Annovera or if you decide to switch permanently.

Use Medfinder to check pharmacy availability for any of these medications. And for more on Annovera costs and savings, read our guide: How to save money on Annovera in 2026.