How to Help Your Patients Save Money on Depo-SubQ Provera 104: A Provider's Guide to Savings Programs

Depo-SubQ Provera 104 is a brand-name-only injectable with no FDA-approved generic, which means cost can be a significant barrier for uninsured, underinsured, or high-deductible patients. As the prescribing provider, you play an important role in connecting patients with savings resources before cost causes them to delay or discontinue their contraception or endometriosis treatment. This guide covers every major savings pathway available in 2026.

Understanding the Cost Landscape

Without insurance or a discount program, Depo-SubQ Provera 104 costs approximately $59–$100 per injection at retail pharmacies. Since no generic exists, there is no lower-cost branded substitute with the same subcutaneous formulation. For patients who pay cash or have high deductibles, this amounts to $236–$400 per year for the medication alone — before factoring in administration fees if received in a provider's office or clinic.

Savings Pathway 1: ACA Contraceptive Mandate — $0 Copay for Most Patients

Under the Affordable Care Act (ACA) contraceptive mandate, non-grandfathered private health insurance plans are required to cover all FDA-approved contraceptive methods without patient cost-sharing. This includes Depo-SubQ Provera 104 when prescribed for contraception.

Clinical tip: If your practice administers Depo-SubQ Provera 104 in-office, ensure the medication and administration are billed as preventive contraceptive services. Code the diagnosis correctly — ICD-10 code Z30.44 (encounter for supervision of contraceptive injection) supports the preventive/contraceptive framing that triggers $0 cost-sharing under the ACA. If the primary indication is endometriosis (N80.x), the visit may be billed differently, and standard drug cost-sharing may apply.

Savings Pathway 2: Pfizer RxPathways — Patient Assistance for Uninsured/Underinsured

Pfizer's RxPathways program is the primary manufacturer-sponsored assistance pathway for Depo-SubQ Provera 104. Eligible patients may receive the medication at no cost. Here are the key details providers need to know:

Program name: Pfizer RxPathways

Phone: 1-877-744-5675

Website: pfizerrxpathways.com

Eligibility: Most uninsured/underinsured patients with limited income qualify. Insured and Medicare Part D patients may also be eligible under certain criteria.

How to apply: Applications can be submitted through the program website or with the provider's assistance by mail or fax. Your staff can assist patients in completing the application during their visit.

Provider samples: Healthcare providers can request Depo-SubQ Provera 104 samples for their office through PfizerPro or by calling 800-505-4426. This can bridge the gap for patients while their assistance application is processed.

Savings Pathway 3: Medicaid Coverage

For patients on Medicaid, contraceptive injectables including Depo-SubQ Provera 104 are typically covered at low or $0 copay in most states. Medicaid family planning expansions in many states also provide contraceptive coverage to individuals who wouldn't otherwise qualify for comprehensive Medicaid. If your patient doesn't have insurance, reviewing their Medicaid eligibility before their first appointment can prevent a surprise cost conversation at the front desk.

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Savings Pathway 4: Title X Clinics and Federally Qualified Health Centers

For patients who cannot afford care even with insurance, referring to a Title X-funded family planning clinic or Federally Qualified Health Center (FQHC) is a viable pathway. These clinics provide contraceptive services on a sliding-scale fee basis based on income. For very low-income patients, this can result in $0 out-of-pocket costs for both the medication and administration. Use findahealthcenter.hrsa.gov to locate FQHCs in your area.

Savings Pathway 5: GoodRx and Pharmacy Discount Programs

For patients who are paying cash — either due to a high deductible or no insurance — pharmacy discount programs like GoodRx and SingleCare can reduce the retail price significantly. With these programs, patients can typically obtain Depo-SubQ Provera 104 for approximately $53–$59 per injection. Consider printing a GoodRx coupon as a routine part of discharge instructions for uninsured patients.

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In-Office Administration: Billing Considerations

When administering Depo-SubQ Provera 104 in your office, proper coding is essential to ensure patients receive the correct coverage:

J-Code: J1051 — Medroxyprogesterone acetate for injectable suspension (use for medical billing of the drug itself)

ICD-10 for contraception: Z30.44 — Encounter for supervision of contraceptive injection (triggers ACA $0 copay for eligible patients)

ICD-10 for endometriosis: N80.x — Endometriosis (when used for endometriosis pain; standard drug benefits apply)

Verify payer-specific policies, particularly for patients with Medicare Part B (which may cover the administration fee for in-office injections) versus Part D (which covers the drug dispensed at a pharmacy).

When Depo-Provera CI Is a More Affordable Option

If cost is a persistent barrier and the subcutaneous formulation is not clinically required, consider transitioning appropriate patients to generic Depo-Provera CI (medroxyprogesterone acetate 150 mg IM). Generic DMPA-IM is widely available, typically costs $15–$50 per injection at retail with discount programs, and uses the same active ingredient with the same dosing schedule. For most patients using Depo-SubQ Provera 104 for contraception only (not endometriosis), this is a clinically reasonable switch.

Quick Reference: Savings Options Summary

ACA-compliant insurance (contraception): $0 copay — use ICD-10 Z30.44

Pfizer RxPathways: $0 for eligible uninsured/underinsured patients — pfizerrxpathways.com, 1-877-744-5675

Medicaid: Very low or $0 copay — verify state-specific coverage

FQHC / Title X clinics: Sliding scale — findahealthcenter.hrsa.gov

GoodRx / SingleCare: Starting ~$53–$59/injection for cash payers

Generic DMPA-IM (Depo-Provera CI generic): $15–$50/injection for appropriate patients

To help your patients find which pharmacies have Depo-SubQ Provera 104 in stock — in addition to saving money — use medfinder for Providers. medfinder contacts pharmacies near your patient's location to check real-time availability, reducing the phone tag your staff and patients face.

Share our patient-facing savings guide with patients: How to Save Money on Depo-SubQ Provera 104 in 2026.