Provider briefing: Annovera availability in 2026

If your patients are reporting difficulty filling Annovera prescriptions, they're not wrong — and you're not alone in hearing it. Despite being FDA-approved since 2018 and actively manufactured by Mayne Pharma, Annovera (segesterone acetate and ethinyl estradiol vaginal system) remains one of the more challenging contraceptives for patients to locate at retail pharmacies.

This guide provides a concise overview of the current supply landscape, prescribing implications, and practical tools you can use to help your patients access Annovera.

Timeline: How we got here

Understanding the context helps frame the current situation:

• August 2018: FDA approved Annovera as the first year-long, patient-controlled vaginal ring contraceptive, developed by the Population Council.
• 2019–2020: Initial commercial launch under TherapeuticsMD. Slow uptake due to high cost, limited formulary inclusion, and the COVID-19 pandemic.
• 2022–2023: Mayne Pharma acquired the Annovera brand and expanded its savings program and distribution efforts.
• 2024–2026: Availability has improved compared to early launch, but pharmacy stocking remains inconsistent. No formal FDA-listed shortage has occurred at any point.

Prescribing implications

Annovera's unique profile creates specific prescribing considerations:

Clinical profile recap

• Mechanism: Combined hormonal contraceptive releasing segesterone acetate (0.15 mg/day) and ethinyl estradiol (0.013 mg/day) — one of the lowest daily EE doses on the market.
• Duration: One ring provides contraception for up to 13 cycles (1 year) with a 21-day in/7-day out cycle.
• Efficacy: Typical-use failure rate is comparable to other combined hormonal contraceptives.
• BMI limitation: Not adequately studied in patients with BMI >29 kg/m². Consider alternative methods for patients above this threshold.
• Boxed warning: Contraindicated in females over 35 who smoke, consistent with all combined hormonal contraceptives.

Drug interactions to monitor

Key interactions that may reduce contraceptive effectiveness or require clinical attention:

• CYP3A4 inducers (rifampin, carbamazepine, phenytoin, St. John's Wort) — counsel patients on backup contraception.
• Hepatitis C regimens containing ombitasvir/paritaprevir/ritonavir — contraindicated.
• Lamotrigine — hormonal contraceptives may decrease lamotrigine levels; monitor and adjust dosing.

For a detailed interactions reference, see: Annovera drug interactions: What to avoid.

The availability picture

Here's what's actually happening on the ground:

No formal shortage

Annovera has never been listed on the FDA Drug Shortage Database. Mayne Pharma continues active manufacturing and distribution. The issue is pharmacy stocking, not supply.

Why pharmacies don't stock it

• Unit cost: Wholesale acquisition cost makes Annovera a significant inventory investment ($2,670–$3,275 retail per ring).
• Low volume: Most pharmacy locations fill only a handful of Annovera prescriptions per month, if any.
• No generic: Without generic competition, there are fewer distributors and less price flexibility.
• Insurance friction: Prior authorization requirements and step therapy protocols reduce fill rates.

Impact on patient care

The practical effect: patients receive a prescription they can't immediately fill, leading to frustration, delayed contraceptive starts, and in some cases, gaps in pregnancy prevention. Proactive prescriber guidance can significantly reduce these barriers.

Cost and access for patients

• Cash price: $2,670–$3,275 for one ring (one-year supply).
• ACA coverage: Most private plans must cover at least one contraceptive per delivery category. However, some plans may prefer NuvaRing/Eluryng and require a step therapy exception for Annovera.
• Manufacturer savings: The Annovera Patient Savings Program can reduce insured patients' cost to $0. Not available for government-insured patients (Medicare, Medicaid, TRICARE). Details at annovera.com/savings-information.
• Discount cards: SingleCare and GoodRx may offer prices around $2,200–$2,500 for uninsured patients.

For a patient-facing cost guide, direct patients to: How to save money on Annovera.

Tools and resources for your practice

Here's how to proactively support patients prescribed Annovera:

Medfinder for Providers

Medfinder is a free tool that helps providers and patients identify pharmacies with specific medications in stock. You can direct your patients to search for Annovera availability by zip code — or use it yourself to identify reliable pharmacy partners in your area.

Pharmacy relationship management

• Identify 1–2 pharmacies in your area that reliably stock or can order Annovera.
• Consider partnering with an independent or specialty pharmacy that handles women's health products.
• Provide patients with pharmacy-specific guidance at the time of prescribing — don't leave them to discover availability problems on their own.

Prior authorization support

When insurance requires prior authorization, submit it proactively at the time of prescribing rather than waiting for a pharmacy rejection. Include clinical rationale for why Annovera is preferred over monthly alternatives (e.g., patient adherence, convenience, lower daily EE dose).

Looking ahead

Several developments may improve Annovera access over time:

• Expanding formulary coverage as payers become more familiar with the product and ACA enforcement continues.
• Potential generic development — though no generic application has been announced, eventual patent expiration could open the market.
• Growing provider awareness and prescribing rates, which increase pharmacy demand and stocking incentives.

Final thoughts

Annovera offers a unique clinical profile — year-long duration, patient-controlled, reversible, and one of the lowest daily estrogen doses available. The access challenges are real but manageable with proactive prescribing practices and the right tools.

Direct patients to Medfinder and the Annovera savings program. For a guide you can share with patients, see: Annovera shortage update: What patients need to know in 2026.

For a practical workflow on helping patients locate Annovera, see our companion guide: How to help your patients find Annovera in stock.