Provider Briefing: Loestrin Fe 1/20 28 Day Supply Disruption

If your patients have been reporting difficulty filling prescriptions for Loestrin Fe 1/20 28 Day or its generic equivalents, you're likely fielding more calls, prior authorization requests, and therapeutic substitution discussions than usual. This briefing covers the current state of the shortage, its implications for your practice, and actionable steps to keep your patients on effective contraception.

Timeline: How We Got Here

The availability challenges around norethindrone acetate/ethinyl estradiol 1 mg/20 mcg combination products have evolved over several years:

• 2013-2014: Warner Chilcott (later Allergan) discontinued brand-name Loestrin Fe 1/20 in favor of Minastrin 24 Fe, a chewable reformulation with extended patent protection. The market shifted entirely to generic equivalents.
• 2023: Multiple generic oral contraceptive products began appearing on the FDA Drug Shortage list. Manufacturing consolidation and API supply issues affected several norethindrone-containing products.
• 2024-2025: Intermittent shortages continued. Key manufacturers including Teva, Aurobindo, and Lupin reported production delays at various points. Some pharmacies experienced weeks-long stockouts of specific NDCs.
• Early 2026: Supply has partially stabilized, but availability remains inconsistent across regions. Not all generic versions are reliably stocked at all pharmacies.

Prescribing Implications

The practical impact on prescribers includes:

Therapeutic Substitution Considerations

All of the following are AB-rated generics containing norethindrone acetate 1 mg / ethinyl estradiol 20 mcg / ferrous fumarate 75 mg:

• Junel Fe 1/20
• Microgestin Fe 1/20
• Blisovi Fe 1/20
• Larin Fe 1/20
• Gildess Fe 1/20
• Hailey Fe 1/20

Pharmacists can generally substitute between these without a new prescription, provided the Rx permits generic substitution. However, patients frequently report that their pharmacy has none of these in stock — which is when prescriber intervention becomes necessary.

When to Consider a Different Formulation

If no norethindrone acetate/EE 1/20 product is available, consider:

• Lo Loestrin Fe: Norethindrone acetate 1 mg / EE 10 mcg. Lower estrogen may benefit patients with estrogen-related side effects. Requires a new prescription. Brand-only, higher cost (~$150-$200/pack without savings card).
• Minastrin 24 Fe: Same hormones, but 24 active tablets + 4 iron tablets (vs. 21/7 in Loestrin Fe 1/20). Chewable formulation. May have different availability and cost profile.
• Other low-dose COCs: Levonorgestrel/EE combinations (e.g., Levlen, Alesse generics) if the patient has no specific need for norethindrone acetate.

Prescription Writing Best Practices During Shortages

To maximize your patient's ability to fill their prescription:

• Write for the generic name: "norethindrone acetate/ethinyl estradiol 1 mg/20 mcg tablets with ferrous fumarate" rather than a specific brand or generic name.
• Explicitly allow generic substitution.
• Consider writing for 90-day supplies when insurance permits — this reduces the frequency of refill-related stockout encounters.
• Include a note or DAW code that permits any AB-rated equivalent.

Current Availability Picture

As of February 2026:

• Generic supply is inconsistent but not critically short nationwide. Most regions have at least one generic version available at some pharmacies.
• Independent pharmacies and those using secondary wholesalers tend to have better availability than major chains.
• Mail-order pharmacies generally maintain more reliable inventory.
• The FDA Drug Shortage database should be monitored for updates on specific NDCs.

Cost and Access Considerations

Cost should not be a significant barrier for most patients:

• ACA mandate: Most commercial insurance plans are required to cover at least one form of each contraceptive method — including oral contraceptives — with no cost-sharing. Generics are almost always covered at $0.
• Discount cards: For uninsured patients, discount programs (GoodRx, SingleCare) bring generic prices to $9-$25 per pack.
• Patient assistance: For patients without insurance or with high out-of-pocket costs, programs like NeedyMeds and RxAssist can connect them with additional savings.

For a patient-facing resource on cost savings, you can direct patients to: How to save money on Loestrin Fe 1/20 28 Day.

Tools and Resources for Providers

Several tools can help streamline the process of connecting patients with available inventory:

• Medfinder for Providers: Search for Loestrin Fe 1/20 28 Day and its generics to see which pharmacies in your patient's area have stock. This eliminates the back-and-forth of calling pharmacies.
• FDA Drug Shortage Database: Monitor current and resolved shortages for norethindrone acetate/ethinyl estradiol products.
• Telehealth partnerships: If your practice doesn't offer telehealth, consider referring patients to telehealth birth control services that can quickly adjust prescriptions and locate pharmacies with stock.

Looking Ahead

The oral contraceptive supply chain is expected to continue stabilizing through 2026 as:

• Additional generic manufacturers ramp up production
• API supply chains recover from pandemic-era disruptions
• Pharmacy inventory management tools become more widely adopted

However, localized shortages may persist, particularly for less commonly stocked generics. Proactive prescription writing and familiarity with alternative formulations remain the best defense against patient disruption.

Final Thoughts

The Loestrin Fe 1/20 28 Day shortage has been a persistent challenge, but it's manageable with the right strategies. Write flexible prescriptions, keep a short list of therapeutic alternatives ready, and direct your patients to tools like Medfinder to find their medication in stock.

For a patient-facing version of this information, you can share: Loestrin Fe 1/20 28 Day shortage update for patients. For a step-by-step provider workflow, see: How to help your patients find Loestrin Fe 1/20 28 Day in stock.