Your Patients Are Struggling to Find Their Birth Control — Here's How You Can Help

As a prescriber, you've likely heard from patients who can't fill their Junel 1/20 21 Day prescription. Maybe they've called your office asking for a new prescription for a different brand. Maybe they've gone weeks without their oral contraceptive because they couldn't find it in stock. These situations are more common than they should be — and they have real clinical consequences.

This guide provides a practical, step-by-step approach to help your patients maintain access to Junel 1/20 21 Day (Norethindrone Acetate 1 mg / Ethinyl Estradiol 20 mcg) or an appropriate alternative during periods of limited availability.

Current Availability: What You Need to Know

Junel 1/20 21 Day, manufactured by Teva Pharmaceuticals, has experienced intermittent pharmacy-level stock issues since 2023. Key points:

• Not currently listed on the FDA Drug Shortage Database
• National manufacturing continues, but distributor allocation limits pharmacy-level stock
• Chain pharmacies in high-volume areas are most affected
• Independent pharmacies and mail-order services tend to have better availability
• Regional variation is significant — the same chain may have stock at one location but not another

For a detailed timeline and background, see our provider briefing: Junel 1/20 21 Day Shortage: What Providers Need to Know.

Why Patients Can't Find It

Understanding the root causes helps you counsel patients effectively:

Distributor Allocation

Wholesale drug distributors (McKesson, Cardinal Health, AmerisourceBergen) allocate limited supplies to pharmacies during periods of tight inventory. A pharmacy may want to order more but cannot exceed its allocation. This is the single biggest driver of the "my pharmacy doesn't have it" complaint.

Brand-Specific Prescriptions

Prescriptions that specify "Junel 1/20" without permitting substitution prevent pharmacists from dispensing equivalent generics like Microgestin 1/20 or Larin 1/20, even when those products are on the shelf. This is an easily addressable prescribing-level issue.

Insurance Formulary Restrictions

Some formularies designate a specific generic brand as preferred. If the preferred brand is unavailable, patients may face a higher copay or need prior authorization for the available equivalent — creating delays and cost barriers.

Patient Awareness

Many patients don't realize that multiple brands contain the same medication. They may not know to ask for alternatives or may be hesitant to switch without guidance from their prescriber.

What Providers Can Do: 5 Practical Steps

Step 1: Write Flexible Prescriptions

The simplest intervention is also the most impactful. When prescribing Junel 1/20 or its equivalents:

• Write for the generic name: Norethindrone Acetate 1 mg / Ethinyl Estradiol 20 mcg
• Explicitly allow generic substitution (avoid DAW codes unless clinically necessary)
• Consider noting in the prescription or patient chart: "May substitute any AB-rated equivalent"

This gives pharmacists maximum flexibility to fill from available stock.

Step 2: Pre-Authorize Alternatives

Document in the patient's chart which alternative brands or formulations are acceptable. This allows your staff to quickly respond to pharmacy substitution requests without requiring a provider callback. Acceptable AB-rated equivalents include:

• Microgestin 1/20
• Larin 1/20
• Aurovela 1/20
• Gildess 1/20
• Hailey 1/20
• Blisovi Fe 1/20 (28-day with iron)
• Tarina Fe 1/20 (28-day with iron)

Step 3: Direct Patients to Medfinder

Medfinder for Providers is a real-time pharmacy availability tool that shows which pharmacies currently have specific medications in stock. You can:

• Recommend patients check medfinder.com before driving to the pharmacy
• Have front-desk staff search Medfinder when patients call about fill issues
• Include the Medfinder URL on patient handouts or after-visit summaries

Step 4: Prescribe 90-Day Supplies When Possible

Longer supplies reduce the frequency of refill interactions and give patients a larger buffer against temporary shortages. Many insurance plans support 90-day fills through mail-order pharmacies. This also reduces the administrative burden on your practice from repeated refill requests and substitution authorizations.

Step 5: Proactively Counsel on Backup Contraception

For patients who are at risk of supply-related gaps, include contraceptive contingency counseling in your routine visits:

• Advise patients to refill 5–7 days before their current pack runs out
• Discuss condom use as backup during any unplanned gaps
• Review missed-pill protocols so patients know what to do if they start a new pack late
• Consider whether a long-acting reversible contraceptive (LARC) might be appropriate for patients who experience frequent access issues

Alternatives to Consider

If Junel 1/20 and all its AB-rated equivalents are unavailable, consider these clinically similar options:

• Lo Loestrin Fe: Norethindrone Acetate 1 mg / EE 10 mcg — lower estrogen, 24/2/2 regimen. Brand-name, potentially higher cost.
• Yaz / Gianvi: Drospirenone 3 mg / EE 20 mcg — different progestin, FDA-approved for acne and PMDD. Monitor potassium in patients on ACE inhibitors, ARBs, or potassium-sparing diuretics.
• Levonorgestrel/EE 20 mcg combinations: Different progestin, same estrogen dose. Widely available generics.

For a patient-friendly comparison: Alternatives to Junel 1/20 21 Day.

Workflow Tips for Your Practice

Integrate shortage management into your clinical workflow to reduce disruption:

Create a Shortage Response Protocol

1. Identify affected patients: Run a report for patients prescribed Junel 1/20 or Norethindrone Acetate/EE 20 mcg
2. Batch-update charts: Add acceptable alternatives to these patients' records proactively
3. Prepare a patient handout: Include information about equivalent generics, Medfinder, and what to do during a gap
4. Train front-desk and nursing staff: Empower them to authorize documented substitutions without provider sign-off for each call

Leverage Telehealth for Quick Pivots

When a patient calls because their pharmacy is out of stock, a brief telehealth visit or secure message exchange can be faster than a callback workflow. The provider can verify the situation, authorize a substitution or write a new prescription, and the patient can fill the same day.

Track and Report

If you see a pattern of supply issues, report it to the FDA Drug Shortage Staff (fda.gov/drugs/drug-shortages). Clinician reports help the FDA identify shortages that may not appear in manufacturer data.

Patient-Facing Resources to Share

These articles are written at a patient reading level and can be shared directly:

• Why Is Junel 1/20 21 Day So Hard to Find?
• How to Find Junel 1/20 21 Day in Stock Near You
• How to Save Money on Junel 1/20 21 Day
• How to Check If a Pharmacy Has Junel 1/20 21 Day in Stock

Final Thoughts

Medication access issues shouldn't fall solely on patients to solve. By writing flexible prescriptions, pre-authorizing equivalents, and connecting patients with real-time tools like Medfinder, you can significantly reduce the burden on both your patients and your practice.

The supply situation for Junel 1/20 21 Day is unlikely to resolve overnight, but with proactive strategies in place, you can ensure your patients maintain consistent contraceptive coverage. For a detailed cost-saving guide you can share with patients, see: How to Help Patients Save Money on Junel 1/20 21 Day.