How to Help Your Patients Save Money on Opill 28 Day: A Provider's Guide to Savings Programs

The OTC approval of Opill (norgestrel 0.075 mg) in July 2023 was celebrated as a breakthrough for contraceptive access. But ironically, OTC status created a new cost barrier for many patients. Under the Affordable Care Act, most health insurance plans must cover FDA-approved contraceptive methods at no cost — but that mandate applies to prescription drugs. Opill bought over the counter without a prescription often does not trigger this coverage.

This means a patient who previously received prescription birth control at $0 copay may now face $19.99/month — or $240/year — for the same protection when buying Opill OTC. For cost-sensitive patients, including uninsured patients, those on public programs, and adolescents, this gap can undermine the very access that OTC approval was meant to create.

As a provider, you have several practical tools at your disposal to help patients access Opill at lower or no cost. This guide covers them all.

Strategy 1: Write a Prescription for Opill to Enable ACA Coverage

The most impactful single action you can take is to write a prescription for Opill (norgestrel 0.075 mg). Even though the medication is OTC, a prescription changes how insurance processes it — bringing it under the ACA's contraceptive mandate, which requires most private health insurance plans to cover FDA-approved contraceptives at no cost to the patient.

How to prescribe Opill for insurance coverage:

Rx: Norgestrel 0.075 mg tablets (Opill) — Dispense: 28 tablets, Refills: 11 (for a 1-year supply with initial fill)

Advise patients to take the prescription to their pharmacy — not necessarily the store's OTC shelf — and ask the pharmacy to process it through their insurance

Encourage patients to call their insurer first to confirm whether norgestrel 0.075 mg is covered on their formulary with a prescription

Some insurers may require the patient to use a specific network pharmacy — advise them to ask

This can be done during a routine visit, telehealth encounter, or via a patient message in your EHR — no dedicated visit is required in most cases.

Strategy 2: Know Which Plans Already Cover OTC Opill

Some pharmacy benefit managers have proactively added OTC Opill to their formulary. Notably, certain CVS Caremark pharmacy benefit plans now cover OTC norgestrel 0.075 mg at $0 without a prescription. Patients enrolled in these plans do not need a prescription to get Opill at no cost — they simply show their insurance card at the OTC pharmacy counter.

For patients enrolled in CVS Caremark plans (common for patients with employer-sponsored insurance through large companies), it's worth advising them to ask at the CVS pharmacy counter whether their plan covers OTC Opill at $0 before purchasing out of pocket.

Strategy 3: Help Patients Access Opill Through Medicaid

Coverage for Opill through Medicaid varies by state. Some state Medicaid programs cover OTC contraceptives, including norgestrel, particularly in states that have adopted expanded OTC Medicaid contraceptive benefits. For patients who are Medicaid-enrolled:

Check your state's Medicaid formulary for norgestrel 0.075 mg coverage

Writing a prescription for Opill may allow it to be covered by Medicaid even in states that don't automatically cover OTC products

For patients who don't qualify for Medicaid, discuss whether they may be eligible for free Opill through the donation program (see below)

Strategy 4: Connect Patients to the Perrigo Donation Program

Perrigo coordinates a donation program that distributes free packs of Opill to eligible patients through participating health centers and clinics. This program is designed specifically for patients who cannot afford to purchase Opill at retail prices.

Participating sites typically include:

Federally Qualified Health Centers (FQHCs)

Title X family planning clinics

Planned Parenthood health centers

Community health organizations participating in the program

If you operate or are affiliated with an FQHC, Title X clinic, or similar organization, you may be able to enroll to receive donated Opill supplies for distribution to your patients. For clinic enrollment or patient referral information, visit opill.com.

Strategy 5: Advise Patients on HSA/FSA Eligibility

Opill is eligible for purchase using Health Savings Account (HSA) or Flexible Spending Account (FSA) funds. For patients who have these accounts, purchasing Opill with pre-tax dollars effectively reduces their net cost by their marginal tax rate. For example, a patient in the 22% tax bracket who purchases $180/year of Opill via HSA saves approximately $40 compared to purchasing with after-tax dollars.

Advise patients to check with their HSA/FSA plan administrator to confirm Opill eligibility and approved retailers or reimbursement processes.

Strategy 6: When to Recommend a Prescription Progestin-Only Alternative

Sometimes the most cost-effective path is not Opill itself, but a prescription progestin-only alternative that is fully covered by insurance at $0. Norethindrone 0.35 mg (Errin, Camila, Heather) is clinically similar to Opill — progestin-only, same 3-hour timing window — and is generally covered at $0 under the ACA contraceptive mandate through health insurance.

Consider recommending norethindrone or another covered prescription POP for cost-sensitive patients who have insurance and where OTC Opill coverage cannot be easily obtained. The clinical profile is comparable, and the coverage difference can save the patient $200 or more per year.

Bulk Ordering Guidance to Share With Patients

For patients who do purchase Opill OTC, encourage them to buy in bulk to reduce the effective monthly cost:

1-month pack (28 tabs): $19.99 ≈ $19.99/month

3-month pack (84 tabs): $49.99 ≈ $16.66/month

6-month pack (168 tabs): $89.99 ≈ $15.00/month — best value with auto-shipping 5% discount

Purchasing 6-month supplies saves approximately $60/year compared to monthly purchases. Auto-shipping from opill.com or GoodRx adds an additional 5% discount and ensures patients don't run out.

How medfinder Supports Your Patients

For patients who need help locating Opill or any other medication near them, medfinder for providers is a paid service that calls pharmacies near your patients to check real-time stock and texts them results. This is particularly useful for patients in areas where Opill stocking is inconsistent, or for patients on complex medication regimens who need help locating specific formulations.

For a companion guide on helping patients locate Opill in stock, see our provider's guide to finding Opill in stock.