Cost Is the Biggest Barrier to Orilissa Adherence

You prescribed Orilissa because it was the right clinical choice. But if your patient can't afford to fill the prescription — or abandons it after the first month's bill — the treatment fails before it starts.

Orilissa (Elagolix) carries a cash price of $1,200 to $1,700 per month, and there is no generic available as of 2026. Even with commercial insurance, copays can run into the hundreds. For patients on Medicare, coverage is often unavailable entirely.

This guide is designed to help you — the prescriber — navigate the savings landscape so you can proactively connect patients with the resources that keep Orilissa affordable and treatment on track.

What Patients Are Actually Paying

Understanding the real-world cost picture helps frame the conversation:

• Cash price (no insurance): $1,200–$1,700/month for a 28-day supply
• Commercial insurance with prior auth: Copays range widely — some patients pay $50–$100/month, others face $300+ depending on formulary tier
• Step therapy requirements: Many payers require documented failure of first-line options (NSAIDs, hormonal contraceptives) before approving Orilissa
• Medicare Part D: Orilissa is typically not covered. Medicare patients face the full cash price unless they qualify for patient assistance.
• Medicaid: Coverage varies by state. Some state Medicaid programs cover Orilissa with prior authorization; others do not.

The most common scenario: the patient has commercial insurance, gets prior authorization approved, and still faces a copay that feels unmanageable. This is where manufacturer savings programs make the biggest difference.

Manufacturer Savings Programs

AbbVie Orilissa Savings Card

This is the single most impactful cost-reduction tool for commercially insured patients:

• Eligible patients may pay as little as $5 per month
• Available to patients with commercial (private) insurance
• Not valid for patients with government insurance (Medicare, Medicaid, Tricare, VA)
• Patients can enroll at orilissa.com or by calling 1-800-222-6885
• The card can be used at retail and specialty pharmacies

Clinical workflow tip: Have your staff mention the savings card at the time of prescribing — ideally before the patient gets to the pharmacy and encounters sticker shock. Consider keeping printed enrollment information in exam rooms or having your MA text the link to patients as part of the checkout process.

myAbbVie Assist (Patient Assistance Program)

For patients who are uninsured or underinsured and meet income eligibility requirements:

• Provides Orilissa at no cost to qualifying patients
• Apply at abbvie.com/myAbbVieAssist or call 1-800-222-6885
• Requires proof of income and insurance status
• Processing typically takes 1–2 weeks

This program is particularly important for patients who have lost insurance coverage or who are in the Medicare coverage gap. Encourage your office staff to become familiar with the application process — it's straightforward but does require your signature as the prescribing provider.

Coupon and Discount Cards

For patients who don't qualify for the manufacturer savings card (government insurance) or who want additional options, third-party discount cards can help — though the savings on a high-cost brand like Orilissa are typically more modest than with generics.

Options to Consider

• GoodRx — Shows pharmacy-specific pricing and occasionally offers coupons for Orilissa. Savings vary significantly by pharmacy.
• SingleCare — Another discount card option worth checking for competitive pricing.
• RxSaver — Compares prices across local pharmacies.
• Optum Perks — May offer discounts at select pharmacies.

Important caveat: Discount cards typically provide 10–20% off the cash price for brand-name drugs, which still leaves Orilissa at $1,000+ per month. These cards are most useful as a backup, not a primary savings strategy. The AbbVie savings card is almost always the better option for commercially insured patients.

For a complete list of savings resources from the patient perspective, see our patient-facing guide on how to save money on Orilissa.

Generic Alternatives and Therapeutic Substitution

Generic Orilissa

There is no generic Elagolix available as of 2026. Orilissa remains patent-protected, and AbbVie is the sole manufacturer. This means generic substitution is not an option.

Therapeutic Alternatives

When cost is prohibitive and savings programs are insufficient, consider therapeutic alternatives based on the patient's clinical picture:

• Myfembree (Relugolix/Estradiol/Norethindrone) — Another oral GnRH antagonist, but as a combination product with add-back therapy. Check if the patient's insurance has more favorable coverage for Myfembree. In some cases, one GnRH antagonist is preferred on formulary over the other.
• Lupron Depot (Leuprolide) — GnRH agonist injection. Has been available longer and may have different formulary placement. Requires office administration, which means an office visit charge but no pharmacy copay issue.
• Norethindrone Acetate — Progestin therapy, used off-label for endometriosis. Available as a generic for under $30/month. Different mechanism but effective for many patients with mild to moderate endometriosis pain.
• Depo-Provera (Medroxyprogesterone) — Injectable progestin, approximately $50–$100 per injection every 3 months. Administered in-office.

Therapeutic substitution conversations should be clinically driven, but cost reality is part of the clinical picture. A treatment the patient can't afford is a treatment that doesn't work.

For a detailed comparison, see our clinical overview of alternatives to Orilissa.

Building Cost Conversations into Your Workflow

Patients don't always volunteer that they can't afford a medication. Some will simply not fill the prescription. Others will fill it once and then stop. Here's how to make cost part of the clinical conversation:

At the Point of Prescribing

• Name the cost proactively: "Orilissa costs about $1,200 to $1,700 per month without insurance, but most of my patients end up paying much less. Let me make sure we connect you with the right savings program."
• Ask about insurance type: Commercial vs. government insurance determines which programs are available.
• Hand off to your team: Train your medical assistants or care coordinators to handle savings card enrollment, prior authorization, and PAP applications.

At Follow-Up Visits

• Ask if they're still filling: "Have you had any trouble getting or paying for your Orilissa?"
• Watch for gaps: If a patient reports symptom return, cost-related non-adherence may be the reason.
• Reassess savings options: Insurance changes (job loss, plan switch) can change what programs a patient qualifies for.

Staff Training

Your front-desk staff and MAs interact with patients at critical moments. Consider:

• Creating a one-page "Orilissa Cost Resources" sheet for staff to reference
• Including savings card enrollment as a checkbox in your prescription workflow
• Designating one team member as the "prior auth point person" for specialty medications

Helping Patients Find Orilissa in Stock

Cost isn't the only barrier — availability can be an issue too. Orilissa is a specialty medication that many retail pharmacies don't routinely stock. If your patient has the prescription and the coverage but can't find it at their pharmacy:

• Consider sending prescriptions to a specialty pharmacy that regularly carries Orilissa
• Direct patients to Medfinder for Providers to check pharmacy availability
• For more on availability issues, see our provider guide on helping patients find Orilissa in stock

Final Thoughts

Orilissa is a clinically valuable treatment for moderate to severe endometriosis pain, but its cost can derail treatment before it starts. The key to keeping patients on therapy is proactive cost management: enroll commercially insured patients in the AbbVie savings card at the time of prescribing, connect uninsured patients with myAbbVie Assist, and be ready with therapeutic alternatives when cost barriers remain.

Making cost conversations a standard part of your Orilissa prescribing workflow — rather than an afterthought — is the most effective thing you can do to improve adherence and outcomes.

For real-time pharmacy availability, visit Medfinder for Providers.