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

As a prescriber, you already know that the best contraceptive is the one your patient actually uses. But when a patient picks up her Xulane prescription and sees a $150 cash price at the pharmacy counter, adherence becomes a financial decision rather than a clinical one.

Cost-related nonadherence to contraceptives leads to gaps in coverage, unintended pregnancies, and frustrated patients who may stop seeking care altogether. The good news: there are multiple savings pathways for Xulane that many patients — and even some providers — don't know about.

This guide walks through every major savings option so you can integrate cost conversations into your workflow and keep your patients on their prescribed regimen.

What Patients Are Paying for Xulane

Understanding the price landscape helps frame the conversation:

• Cash price (no insurance): $100 to $200 per box of 3 patches (one month's supply)
• With commercial insurance: Typically $0 to $30/month under the ACA contraceptive mandate, though some plans require prior authorization or step therapy
• With Medicaid: Usually covered with no copay
• With discount cards: As low as $47 (GoodRx) to $77 (SingleCare) per box

The patients who need the most help are typically those in the coverage gap: commercially insured with high deductibles or copays, uninsured patients who don't qualify for Medicaid, and patients whose plans require a different contraceptive first.

Manufacturer Savings Programs

Viatris Xulane Savings Card

Mylan/Viatris offers a manufacturer savings card with meaningful savings for commercially insured patients:

• $0 on the first 28-day fill
• $15 on each subsequent fill
• Maximum savings of $425 per calendar year
• Up to 14 fills per year

Eligibility: Commercially insured patients only. Not valid for patients with government insurance (Medicare, Medicaid, TRICARE, VA) or for uninsured/cash-paying patients.

Patients can enroll online at the Viatris website or through the pharmacy at the point of sale. Consider having your front desk staff keep enrollment information available for patients at checkout.

Viatris Patient Assistance Program (PAP)

For uninsured or underinsured patients who meet income requirements, Viatris offers a patient assistance program that provides Xulane at no cost. Patients can apply through viatris.com or by calling the Viatris patient assistance line.

This is particularly valuable for patients who fall outside Medicaid eligibility but cannot afford the cash price. Applications typically require proof of income and insurance status.

Coupon and Discount Card Programs

For patients paying cash or with high copays, third-party discount cards can significantly reduce the out-of-pocket cost:

• GoodRx — Brings Xulane to approximately $47 per box at many pharmacies. Free to use; no registration required.
• SingleCare — Prices around $77 per box. Also free; accepted at most major chains.
• RxSaver, BuzzRx, Optum Perks — Additional discount platforms worth checking, as prices vary by pharmacy.

Important note for your team: Discount cards cannot be combined with insurance. They're an alternative payment pathway — the patient either uses insurance or the discount card, whichever yields the lower price. Pharmacists can often run both to compare.

Consider printing or bookmarking GoodRx pricing for Xulane so you can show patients the cash-price option during the visit if insurance coverage is uncertain.

Insurance Coverage and the ACA Mandate

Under the Affordable Care Act, most commercial insurance plans must cover at least one form of each FDA-approved contraceptive method — including the transdermal patch — with no cost-sharing. This means Xulane should be covered at $0 for many patients.

However, common barriers include:

• Step therapy requirements — Some plans require trying oral contraceptives before approving the patch.
• Prior authorization — Adds delay and paperwork but is usually approvable with clinical justification.
• Formulary preferences — The plan may prefer Zafemy or Twirla over Xulane. If the patient has a clinical reason for Xulane specifically, a formulary exception request may be warranted.

If your patient's plan is denying coverage, the key steps are:

1. Check the plan's formulary to identify preferred alternatives
2. Submit a prior authorization with clinical rationale if Xulane is specifically needed
3. File a formulary exception if the preferred alternative is not appropriate
4. Direct the patient to their plan's appeals process if denied

Generic Alternatives and Therapeutic Substitution

Xulane itself is a branded generic (the generic equivalent of Ortho Evra). Other options in the transdermal contraceptive space include:

• Zafemy — Another Norelgestromin/Ethinyl Estradiol patch (same hormones, same doses, slightly smaller patch). May be preferred on some formularies and could be less expensive depending on the plan.
• Twirla — A brand-name patch containing Levonorgestrel and Ethinyl Estradiol at lower doses. Different hormone profile; may be appropriate for patients concerned about estrogen exposure but carries its own BMI restrictions.

For patients where any combined hormonal contraceptive patch will do, allowing generic substitution or therapeutic alternatives gives the pharmacy flexibility to dispense whichever option is cheapest or most readily available.

If switching from Xulane to an alternative, consider whether the patient has any clinical reason to stay on the specific Norelgestromin formulation. For most patients, the switch is straightforward.

Building Cost Conversations Into Your Workflow

The most effective savings intervention is the one that happens before the patient leaves your office. Here are practical ways to integrate cost into your prescribing workflow:

1. Ask About Coverage Early

Before writing the prescription, ask: "Do you have prescription drug coverage? Do you know if your plan covers birth control at no cost?" This takes 15 seconds and can prevent a surprise at the pharmacy.

2. Prescribe With Flexibility

When clinically appropriate, write the prescription for "Norelgestromin/Ethinyl Estradiol transdermal patch" rather than brand-specific Xulane. This allows the pharmacy to dispense whichever manufacturer is cheapest or in stock.

3. Provide Savings Resources at the Point of Prescribing

Have your staff keep a one-page handout with:

• Viatris savings card enrollment link
• GoodRx and SingleCare as cash-price alternatives
• Viatris PAP information for uninsured patients
• Medfinder for Providers — to help patients locate pharmacies with Xulane in stock

4. Follow Up on Fill Status

If your EHR tracks prescription fill rates, flag patients who haven't filled their Xulane within 7 days. A quick outreach can catch cost-related abandonment early and give you a chance to intervene with savings options.

5. Know Your Local Resources

Title X family planning clinics and federally qualified health centers (FQHCs) can provide contraceptives on a sliding fee scale for patients who need additional financial assistance. Refer patients to findahealthcenter.hrsa.gov for local options.

Quick Reference: Xulane Savings at a Glance

• Commercially insured: Viatris Savings Card → $0 first fill, $15 after
• High-deductible/high-copay: GoodRx (~$47/box) or SingleCare (~$77/box)
• Uninsured, low income: Viatris Patient Assistance Program (free)
• Uninsured, not PAP-eligible: GoodRx/discount cards + Title X clinics
• Government insurance: Usually covered; if not, check formulary for Zafemy or Twirla

Final Thoughts

Cost shouldn't be the reason a patient discontinues effective contraception. With manufacturer savings cards, discount platforms, patient assistance programs, and insurance navigation strategies, there's almost always a pathway to affordable Xulane.

The key is making these conversations routine — not reactive. When cost is addressed proactively at the point of prescribing, patients are more likely to fill their prescriptions, stay adherent, and continue seeking care.

For more clinical resources on Xulane, see our provider shortage guide and pharmacy stock guide for providers. Visit Medfinder for Providers to help your patients locate Xulane at nearby pharmacies.