Cost Is the Biggest Barrier to Phexx Adherence — Here's How to Help

Phexx (Lactic Acid, Citric Acid, and Potassium Bitartrate vaginal gel) is one of the few non-hormonal, on-demand contraceptive options available to your patients. But at a retail price of $795 for 12 applicators, cost can be a significant barrier — especially for uninsured or underinsured patients.

As a prescriber, you're in a unique position to help patients navigate the financial side of their contraceptive care. This guide covers the savings programs, insurance pathways, and alternative strategies you can use to keep Phexx accessible.

What Patients Are Paying for Phexx

Understanding the pricing landscape helps you counsel patients effectively:

• Retail cash price: Approximately $795 for a box of 12 pre-filled applicators
• With commercial insurance: Most plans cover Phexx at $0 copay under the ACA contraceptive mandate
• With coupon cards: SingleCare and similar discount programs can reduce the cash price to approximately $374
• Medicaid: Coverage varies by state; some state programs cover Phexx, others may require prior authorization or step therapy
• Uninsured patients: Face the full retail price unless they access savings programs

The single biggest factor in what a patient pays is whether they have insurance that covers contraceptives under the ACA mandate.

Manufacturer Savings Programs

Evofem Biosciences offers several programs through phexx.com:

Copay Assistance

Commercially insured patients may be eligible for copay assistance that reduces or eliminates their out-of-pocket cost. Direct patients to phexx.com to check eligibility and enroll.

Telehealth + Home Delivery

The Phexx website connects patients with licensed telehealth providers who can prescribe and ship Phexx directly to the patient's home. This can be particularly useful for patients in rural areas, those with transportation barriers, or those whose local pharmacies don't stock Phexx.

Patient Support Line

Patients can contact Evofem at 1-833-EVFMBIO for assistance with coverage, prior authorization support, and enrollment in savings programs.

As a prescriber, consider keeping Evofem's contact information and phexx.com referral materials in your office for quick patient handoffs.

Coupon and Discount Cards

For patients paying cash — whether uninsured or facing coverage gaps — prescription discount cards can significantly reduce costs:

• SingleCare — Offers Phexx for approximately $374 (12 applicators), a savings of over 50% off retail
• GoodRx — Check goodrx.com/phexx for current pricing at pharmacies near your patient
• RxSaver — Another option for comparing cash prices across pharmacies
• BuzzRx, Optum Perks, and others — Various discount platforms may carry Phexx pricing

These cards are free, don't require insurance, and can be used at most major pharmacy chains. You can print coupons directly from these websites or have patients show the digital card on their phone.

For a comprehensive list of savings options, refer patients to our patient savings guide for Phexx.

Insurance and Prior Authorization Tips

ACA Contraceptive Mandate

Under the ACA, most commercial insurance plans must cover all FDA-approved contraceptives — including Phexx — with no cost-sharing. If a patient reports being charged a copay, consider these steps:

1. Verify the pharmacy is billing correctly — Phexx should be billed as a prescription contraceptive, not a "specialty" or "compound" product
2. Contact the insurer — If the plan denies coverage or applies a copay, file an appeal citing the ACA contraceptive mandate
3. Request an exception — Some plans cover only certain contraceptive methods in each category without cost-sharing but must cover alternatives if a provider determines the preferred method isn't medically appropriate

Prior Authorization

Some plans require prior authorization for Phexx. Tips for faster approvals:

• Document why non-hormonal contraception is medically necessary (e.g., contraindications to hormonal methods, history of hormonal side effects, patient preference for on-demand method)
• Include clinical rationale specific to the patient
• Use the insurer's standard PA form and submit it proactively when writing the prescription

Generic Alternatives and Therapeutic Substitution

There is currently no generic version of Phexx. However, if cost is prohibitive and the patient is open to alternatives, consider discussing:

• Nonoxynol-9 spermicides (VCF, Today Sponge) — Available OTC at much lower cost, though with different side effect profile and potentially less favorable tolerability
• Copper IUD (Paragard) — Non-hormonal, long-acting contraception with a one-time insertion cost often covered by insurance
• Condoms — Non-hormonal barrier method available at very low cost or free through public health programs
• Diaphragm with spermicide (Caya) — Another non-hormonal barrier option

For a full comparison of alternatives, see our alternatives to Phexx guide.

When discussing alternatives, note that Phexx's on-demand, user-controlled mechanism is unique. Patients who specifically want a non-hormonal, non-device contraceptive they control at the time of intercourse may not find an exact substitute.

Building Cost Conversations Into Your Workflow

Cost conversations don't have to be awkward or time-consuming. Here are practical strategies:

Normalize the Discussion

Build a standard question into your contraceptive counseling: "Do you have any concerns about the cost of your birth control?" Many patients won't bring up cost on their own but will engage when asked directly.

Use Office Materials

Keep printed or digital resources available:

• Phexx.com savings program information
• SingleCare and GoodRx coupon printouts for Phexx
• Evofem's patient support phone number (1-833-EVFMBIO)
• A link to Medfinder for Providers for pharmacy stock and availability tools

Train Staff

Front-desk and nursing staff can help patients with savings program enrollment, prior authorization paperwork, and pharmacy selection. A quick training session can significantly reduce the burden on providers while improving patient access.

Follow Up

If a patient reports difficulty affording Phexx, follow up at the next visit. Coverage situations change, new savings programs launch, and a patient who couldn't afford Phexx six months ago may have new options today.

Final Thoughts

Phexx fills an important niche in the contraceptive landscape — it's non-hormonal, on-demand, and user-controlled. But at nearly $800 retail, cost can derail adherence before it starts. By proactively connecting patients with insurance coverage, manufacturer programs, and discount cards, you can help ensure that the patients who want Phexx can actually afford it.

For provider tools and pharmacy availability data, visit Medfinder for Providers.