Comprehensive medication guide to Nextstellis 28 Day including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0 with commercial insurance coverage and Mayne Pharma savings card; $25–$50 copay for insured patients without Nextstellis formulary coverage. Medicare Part D generally does not cover Nextstellis.
Estimated Cash Pricing
$240–$303 retail for a 28-tablet pack; as low as $65 with a GoodRx coupon or $25/month with the Mayne Pharma savings card for a 30-day supply.
Medfinder Findability Score
68/100
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Nextstellis 28 Day is a combination oral contraceptive pill approved by the FDA in April 2021. It is manufactured by Mayne Pharma and contains two active ingredients: drospirenone (3 mg), a synthetic progestin, and estetrol (14.2 mg), a novel synthetic estrogen derived from plant sources.
Estetrol (E4) is the first new contraceptive estrogen approved in the United States in over 50 years. Unlike the ethinyl estradiol found in most other oral contraceptives, estetrol is a naturally occurring estrogen that the fetal liver produces during pregnancy, now synthesized from plant sources. It acts selectively on estrogen receptors, which gives Nextstellis a unique pharmacological profile.
Each 28-tablet blister pack contains 24 pink active tablets (with drospirenone and estetrol) and 4 white inactive placebo tablets. There is no FDA-approved generic version of Nextstellis, and patent protection is expected to last at least until 2036.
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Nextstellis prevents pregnancy primarily by suppressing ovulation. The combination of estetrol and drospirenone signals the pituitary gland to reduce production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Without the LH surge that normally triggers egg release, ovulation does not occur. No ovulations were observed in Phase 3 clinical ovulation suppression studies.
Estetrol selectively binds to nuclear estrogen receptor-alpha (ERα) and antagonizes membrane ERα. This tissue selectivity means estetrol has a more targeted hormonal effect than ethinyl estradiol, with demonstrated lower impact on sex hormone-binding globulin (SHBG), liver enzymes, and lipid parameters in Phase 3 trials.
Drospirenone is a spironolactone analogue with three key properties: progestogenic (ovulation suppression, cervical mucus thickening, endometrial thinning), anti-androgenic (reducing acne and androgen-related symptoms), and anti-mineralocorticoid (reducing water retention and bloating). Drospirenone has a half-life of approximately 30 hours, making it well-suited to once-daily dosing.
3 mg / 14.2 mg — tablet
24 pink active tablets (drospirenone 3 mg + estetrol 14.2 mg) + 4 white inert tablets per 28-day blister pack
Nextstellis 28 Day is not on the FDA's official drug shortage list as of 2026, but many patients report difficulty finding it at local pharmacies. The primary reason is that Nextstellis is a brand-name-only medication with no generic, meaning pharmacies must stock the brand itself or nothing at all. Not all pharmacies carry it as a routine item, particularly smaller retail locations or pharmacies without high contraceptive prescription volume.
Most large chain pharmacies (CVS, Walgreens, Rite Aid) can order Nextstellis from their wholesaler within 1–2 business days if not in stock. Hospital-affiliated outpatient pharmacies and mail-order pharmacies tend to have the most reliable supply.
If your local pharmacy doesn't have it, medfinder calls pharmacies near you on your behalf to find which ones have Nextstellis in stock, then texts you the results — saving you hours of hold times.
Nextstellis is not a controlled substance, so there are no special DEA schedule requirements for prescribers. Any licensed provider with prescriptive authority in their state can prescribe Nextstellis as part of routine contraceptive care. Providers should screen patients for contraindications (smoking ≥35 years, thrombotic history, hormone-sensitive cancers, liver disease) before prescribing.
Common prescriber types for Nextstellis include:
Nextstellis can also be obtained through telehealth platforms specializing in women's health and contraception, including Nurx, Hers, Planned Parenthood Direct, Wisp, and others. Telehealth prescriptions can often be filled same-day through partner pharmacies or shipped by mail, which is especially convenient given Nextstellis's inconsistent local pharmacy stocking.
No. Nextstellis 28 Day is not a controlled substance. It is not scheduled under the DEA's Controlled Substances Act and has no abuse potential or dependence liability. Any licensed prescriber with DEA registration is not required to have a special DEA schedule authorization to prescribe it.
As a non-controlled prescription medication, Nextstellis can be prescribed electronically, phoned in, or faxed to a pharmacy. It can be dispensed with up to a 90-day supply, and refills may be written at the time of the original prescription. There are no DEA refill restrictions, special prescription forms, or mandatory in-person visit requirements due to scheduling status.
The following side effects were reported in at least 2% of participants in Phase 3 clinical trials:
Serious side effects requiring immediate medical attention:
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Yaz / Generic Drospirenone-EE 0.02 mg
Same progestin (drospirenone 3 mg) paired with ethinyl estradiol 0.02 mg instead of estetrol. Generics widely available and significantly less expensive. Best alternative for patients who need drospirenone's anti-androgenic properties.
Yasmin / Generic Drospirenone-EE 0.03 mg
Drospirenone 3 mg paired with ethinyl estradiol 0.03 mg in a 21/7 pill pack (21 active, 7 placebo). Generic versions available at most pharmacies.
Slynd (Drospirenone 4 mg)
Progestin-only pill (no estrogen) containing 4 mg drospirenone. Option for patients who cannot use estrogen (migraines with aura, breastfeeding, certain cardiovascular risk factors). Shares Nextstellis's progestin.
Lo Loestrin Fe
Lowest-dose EE combination pill available (norethindrone 1 mg / ethinyl estradiol 10 mcg). Option when minimizing estrogen exposure is the primary clinical goal.
Prefer Nextstellis 28 Day? We can find it.
Rifampin (rifampicin)
majorStrong CYP3A inducer that significantly reduces estetrol and drospirenone levels, potentially causing contraceptive failure. Avoid concomitant use; if unavoidable, use backup contraception during and 28 days after.
Carbamazepine, phenytoin, phenobarbital
majorAnti-seizure medications that are CYP3A inducers. May reduce Nextstellis efficacy. Use backup contraception.
St. John's Wort (Hypericum perforatum)
moderateModerate CYP3A inducer. Can reduce drospirenone and estetrol levels, causing breakthrough bleeding and possible contraceptive failure. Avoid.
Ombitasvir/paritaprevir/ritonavir (Viekira Pak)
majorHepatitis C drug combination. ABSOLUTELY CONTRAINDICATED with Nextstellis — causes significant ALT elevation. Discontinue Nextstellis before starting this regimen.
ACE inhibitors, ARBs, potassium-sparing diuretics
moderateCombined use with drospirenone's anti-mineralocorticoid activity can cause dangerous hyperkalemia (high potassium). Monitor potassium levels.
Strong CYP3A4 inhibitors (fluconazole, clarithromycin)
moderateMay increase drospirenone plasma levels, raising risk of hyperkalemia and other adverse effects. Monitor for adverse events with long-term concomitant use.
Antidiabetic drugs (insulin, metformin)
moderateNextstellis may reduce the blood glucose-lowering effect. Increased glucose monitoring required; dose adjustments may be needed.
Nextstellis 28 Day represents a meaningful advancement in oral contraception — the first new contraceptive estrogen in over 50 years. Its selective estrogen receptor activity, longer half-life, and demonstrated neutral effects on SHBG and liver parameters differentiate it from traditional ethinyl estradiol-based pills. For patients who have struggled with side effects on EE-based pills, Nextstellis may offer a better-tolerated option.
The main practical challenges are cost and availability. Nextstellis is brand-only with no generic, which means retail prices of $240–$303 per pack without discounts. The Mayne Pharma savings card can dramatically reduce this to $0–$25/month for most commercially insured patients. Pharmacy stocking is inconsistent at many retail locations, so patients may need to request a special order, try mail-order, or use a search tool.
If you are having trouble locating Nextstellis at a pharmacy near you, medfinder can call pharmacies on your behalf to find which ones have it in stock, then text you the results. With the right resources, most patients can access and afford Nextstellis in 2026.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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