Cost Is an Adherence Barrier — Here's How to Address It

As a prescriber, you already know that the best medication is the one your patient actually takes. For oral contraceptives like Enpresse 28 Day (Levonorgestrel/Ethinyl Estradiol triphasic), cost shouldn't be a barrier to adherence — but for some patients, it is.

While the ACA contraceptive mandate has dramatically improved access, gaps remain. Patients on grandfathered plans, those between insurance coverage, or individuals with high-deductible plans may still face out-of-pocket costs. Undocumented patients and those without any coverage are often hit hardest.

This guide outlines the savings programs, discount tools, and clinical strategies you can use to help your patients stay on their contraceptive regimen without financial strain.

What Your Patients Are Paying

Here's the current pricing landscape for Enpresse 28 Day and its generic equivalents:

• Brand-name Enpresse (when available): $29 to $75 per 28-tablet pack at cash price. Note: the Enpresse brand has been largely discontinued by Teva Pharmaceuticals.
• Generic Levonorgestrel/Ethinyl Estradiol triphasic (e.g., Trivora-28): $11 to $30 per pack with a discount card.
• With most insurance: $0 copay under the ACA contraceptive mandate for generic formulations. Brand-name products may require step therapy to generic first.

For patients with coverage, generic oral contraceptives are typically Tier 1 on formulary with no prior authorization required. The patients who need the most help are those paying cash — and even then, generic pricing makes this one of the more affordable medications to obtain.

Manufacturer Savings Programs

Since Teva has largely discontinued the Enpresse brand, there is no active manufacturer savings program or copay card for Enpresse specifically. This is actually a non-issue for most patients because:

• Generic equivalents are widely available and affordable
• Most pharmacies will automatically dispense the generic (Trivora-28 or equivalent)
• The generic versions contain identical active ingredients in the same triphasic doses

If a patient specifically requests the brand name, counsel them that the generic is therapeutically equivalent and typically costs significantly less.

Coupon and Discount Cards

For uninsured or underinsured patients, prescription discount cards can reduce out-of-pocket costs to as low as $11 per pack. The most useful platforms include:

• GoodRx — Search for Levonorgestrel/Ethinyl Estradiol triphasic and compare prices across nearby pharmacies. Patients can show the coupon on their phone at the counter.
• SingleCare — Similar savings, accepted at most major chains including CVS, Walgreens, and Walmart.
• RxSaver — Compares prices and provides printable or digital coupons.
• Optum Perks — Free discount card with competitive pricing on generics.
• BuzzRx and America's Pharmacy — Additional options worth checking for lowest price.

A practical tip for your workflow: keep a stack of GoodRx or SingleCare cards at the front desk or in exam rooms. Patients who balk at cost can use one immediately. You can also direct patients to our comprehensive savings guide for Enpresse 28 Day.

Patient Assistance and Safety-Net Programs

For patients with significant financial hardship, several safety-net programs provide oral contraceptives at low or no cost:

• Planned Parenthood clinics — Provide contraceptives on a sliding-fee scale based on income. No insurance required.
• Title X-funded health centers — Federally funded family planning clinics offer confidential contraceptive services regardless of ability to pay.
• State Medicaid programs — All state Medicaid programs cover oral contraceptives. For patients who may be eligible but aren't enrolled, consider connecting them with your facility's financial counselor or social worker.
• NeedyMeds (needymeds.org) — Maintains a database of patient assistance programs, discount cards, and free/low-cost clinic directories.
• RxAssist (rxassist.org) — Another comprehensive directory of assistance programs searchable by medication.

Generic Alternatives and Therapeutic Substitution

Since Enpresse 28 Day is available generically, this is one of the simpler therapeutic categories for cost management. Key considerations:

Direct Generic Equivalents

• Trivora-28 — Same triphasic Levonorgestrel/Ethinyl Estradiol formulation, different manufacturer. This is the most common generic dispensed.
• Other AB-rated generics — Multiple manufacturers produce this triphasic combination. The pharmacy will typically dispense whichever they have in stock.

Therapeutic Alternatives (Different Formulations)

If cost or availability is an issue even with generics, consider these clinically appropriate alternatives:

• Levlen 28 — Monophasic Levonorgestrel/Ethinyl Estradiol. Simpler dosing (same dose every day), same hormones, often widely stocked and very affordable.
• Tri-Sprintec — Triphasic oral contraceptive using Norgestimate/Ethinyl Estradiol. Very widely available generic with competitive pricing.
• Ortho Tri-Cyclen (generic: Tri-Sprintec) — Same as above, also FDA-approved for acne if that's a secondary concern for the patient.

For a more detailed comparison, refer patients to our alternatives to Enpresse 28 Day guide.

When considering therapeutic substitution, weigh the patient's history with the current formulation. If they're stable and tolerating the triphasic Levonorgestrel/Ethinyl Estradiol well, switching for cost alone may not be necessary — especially since the generic is already affordable.

Building Cost Conversations into Your Workflow

Many patients won't volunteer that cost is a barrier. They'll simply stop filling their prescription. Proactively addressing affordability can improve adherence significantly. Here are practical strategies:

At the Point of Prescribing

• Ask about coverage: "Do you have prescription coverage? Are you paying anything out of pocket for your birth control?"
• Default to generic: Always prescribe as "Levonorgestrel/Ethinyl Estradiol triphasic" rather than brand-name Enpresse to ensure the pharmacy dispenses the most affordable option.
• Mention discount cards: A quick "If there's any cost issue, GoodRx or SingleCare can bring this down to about $11 to $15" goes a long way.

At Follow-Up Visits

• Ask about fills: "Have you been able to fill your prescription each month without any issues?"
• Screen for non-adherence: If a patient reports breakthrough bleeding or irregular cycles, cost-related non-adherence (skipping packs or stretching supplies) should be on your differential.
• Reassess annually: Insurance changes happen. A patient who had $0 copays last year may be on a different plan now.

For Your Practice

• Keep a resource sheet with links to discount programs, nearby Title X clinics, and Medicaid enrollment information.
• Connect with your pharmacist: A good pharmacy partner can alert you when patients aren't picking up prescriptions.
• Use Medfinder for Providers to help patients locate pharmacies that have their prescribed formulation in stock — saving both you and the patient time.

Final Thoughts

Enpresse 28 Day — particularly in its generic form — is one of the most affordable prescription medications available. For most insured patients, it's free. For those paying out of pocket, discount cards bring costs to $11 to $30 per month, and safety-net programs can eliminate costs entirely for qualifying patients.

The biggest opportunity isn't finding savings programs (they're abundant) — it's making sure your patients know about them. A brief cost conversation during the prescribing visit, a GoodRx card on the front desk, or a referral to a Title X clinic can be the difference between a patient who fills every pack and one who doesn't.

For more clinical guidance on managing Enpresse 28 Day availability issues, see our provider shortage guide and guide to helping patients find Enpresse 28 Day in stock.