Comprehensive medication guide to Rivelsa 91 Day including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0 copay on most ACA-compliant plans under the contraceptive mandate; $5–$30 copay on plans with coverage tiers; prior authorization may be required if not the formulary-preferred extended-cycle generic.
Estimated Cash Pricing
$426–$448 retail for a 91-tablet pack (3-month supply); as low as $67–$70 with GoodRx or SingleCare coupons.
Medfinder Findability Score
75/100
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Rivelsa 91 Day is an extended-cycle combination oral contraceptive (COC) manufactured by Teva Pharmaceuticals USA. It is the FDA-authorized generic version of Quartette. Each pack contains 91 tablets taken over a 13-week (91-day) cycle, giving patients approximately 4 scheduled periods per year instead of the standard 13.
The medication contains two active hormones: levonorgestrel (a progestin, constant at 0.15 mg) and ethinyl estradiol (a synthetic estrogen that steps up from 0.02 mg to 0.025 mg to 0.03 mg across the 84 active tablets). The final 7 yellow tablets contain a low dose of 0.01 mg ethinyl estradiol only. This quadriphasic step-up estrogen design was developed to reduce the unscheduled breakthrough bleeding common with older monophasic extended-cycle pills.
Rivelsa is FDA-approved for pregnancy prevention and is also used off-label for conditions including endometriosis, dysmenorrhea, menstrual migraines, PCOS, and menstrual-related anemia.
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Rivelsa 91 Day prevents pregnancy through three primary mechanisms. First and most importantly, it suppresses ovulation: the combination of levonorgestrel and ethinyl estradiol provides continuous negative feedback to the pituitary gland, inhibiting the release of FSH and LH. Without the LH surge, the ovary does not release an egg.
Second, the progestin component causes cervical mucus to thicken, making it more difficult for sperm to reach the uterus. Third, Rivelsa alters the uterine lining (endometrium) to make implantation more difficult if fertilization were to occur.
What makes Rivelsa unique is its quadriphasic design: the estrogen dose increases in three steps across the 84 active tablets (0.02 mg → 0.025 mg → 0.03 mg ethinyl estradiol), then drops to 0.01 mg for the final 7 days to trigger a scheduled withdrawal bleed. This graduated estrogen approach maintains uterine lining stability throughout the extended cycle, reducing unscheduled spotting compared to monophasic 91-day alternatives.
0.15 mg / 0.02 mg (Phase 1) — tablet
42 light pink tablets: levonorgestrel 0.15 mg + ethinyl estradiol 0.02 mg
0.15 mg / 0.025 mg (Phase 2) — tablet
21 pink tablets: levonorgestrel 0.15 mg + ethinyl estradiol 0.025 mg
0.15 mg / 0.03 mg (Phase 3) — tablet
21 purple tablets: levonorgestrel 0.15 mg + ethinyl estradiol 0.03 mg
0.01 mg (Phase 4) — tablet
7 yellow tablets: ethinyl estradiol 0.01 mg only (low-dose estrogen; triggers scheduled period)
As of 2026, Rivelsa 91 Day is not on the FDA's official drug shortage list. However, it is routinely out of stock at individual pharmacies due to its lower dispensing frequency (4 fills per year per patient), large pack size, and competition from 15+ other extended-cycle generic brands. Many pharmacies do not stock it routinely and must special-order it within 1-3 business days.
Patients can use medfinder to quickly locate which pharmacies near them have Rivelsa in stock. medfinder calls pharmacies on the patient's behalf and texts results — no hold music, no driving to empty shelves. Mail-order pharmacies are also a reliable source for ongoing Rivelsa refills.
Rivelsa 91 Day is not a controlled substance, so it can be prescribed by any licensed healthcare provider with prescribing authority—no DEA registration required. The following providers commonly prescribe it:
OB/GYN (most common prescriber for extended-cycle contraceptives)
Primary Care Physician (PCP) or Family Medicine physician
Nurse Practitioner (NP) or Certified Nurse-Midwife (CNM)
Physician Assistant (PA)
Planned Parenthood and community health center providers
Rivelsa 91 Day can also be prescribed via telehealth in most US states. Platforms like Nurx, Wisp, and The Pill Club offer online consultations for birth control prescriptions and can ship the medication directly to your home or send the prescription to your local pharmacy.
No. Rivelsa 91 Day is not a controlled substance and is not scheduled by the DEA. It does not require a DEA-licensed prescriber, and it can be prescribed by any licensed healthcare provider with prescribing authority, including nurse practitioners, physician assistants, OB/GYNs, and primary care physicians.
Because Rivelsa is not a controlled substance, prescriptions can include multiple refills and do not require in-person visits as frequently as schedule II-IV medications. Many telehealth providers can prescribe Rivelsa for patients in most states via an online visit.
Common side effects, particularly during the first 1-3 cycles:
Unscheduled spotting or breakthrough bleeding (most common; decreases over time)
Nausea (especially in the first pack; take with food)
Breast tenderness or swelling
Headache
Mood changes or depressive symptoms
Serious side effects — seek emergency care immediately:
Venous thromboembolism (blood clots in legs or lungs): leg pain, swelling, shortness of breath
Stroke: sudden severe headache, vision changes, facial drooping, slurred speech
Heart attack: chest pain, pain radiating to arm or jaw
Severe liver problems: jaundice, severe abdominal pain
New or worsening hypertension
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Ashlyna (91 Day)
Monophasic 91-day generic; same hormones (LNG/EE 0.03 mg + 7-day EE 0.01 mg); more available but lacks Rivelsa's step-up estrogen design
Jolessa (91 Day)
Monophasic 91-day generic with inert placebo pills; may cause slightly heavier scheduled bleeds than Rivelsa
Seasonique (91 Day)
Brand 91-day COC with 10 mcg EE in the last 7 days; higher cost than Rivelsa
NuvaRing (etonogestrel/EE)
Monthly vaginal ring; no daily pill compliance required; different hormone delivery route
Nexplanon (etonogestrel implant)
3-year progestin-only arm implant; highly effective; no daily action required; completely avoids availability issues
Prefer Rivelsa 91 Day? We can find it.
Rifampin
majorPotent CYP3A4 inducer; significantly reduces levonorgestrel and EE levels; use non-hormonal contraception
Anticonvulsants (phenytoin, carbamazepine, phenobarbital, topiramate, oxcarbazepine)
majorCYP3A4 inducers; reduce COC effectiveness; use backup contraception or alternative method
St. John's Wort
majorHerbal CYP3A4 inducer; reduces EE levels; can reduce contraceptive effectiveness
Ombitasvir/paritaprevir/ritonavir (Viekira Pak)
majorContraindicated; causes significant ALT elevations when combined with EE-containing medications
Glecaprevir/pibrentasvir (Mavyret)
majorContraindicated; potential for ALT elevations with EE-containing medications
HIV protease inhibitors and NNRTIs
moderateMay increase or decrease estrogen/progestin levels; consult labeling for each agent
Lamotrigine
moderateCOCs increase lamotrigine metabolism; may reduce seizure control; dose adjustment may be needed
Grapefruit juice
minorCYP3A4 inhibitor; may modestly increase EE exposure
Rivelsa 91 Day is a well-established extended-cycle oral contraceptive offering an innovative quadriphasic design that reduces the breakthrough bleeding common with other 91-day pills. With just 4 periods per year and over 99% effectiveness with perfect use, it is a compelling choice for patients seeking extended-cycle contraception or menstrual management.
The main challenge patients face is pharmacy availability: Rivelsa is not always in stock at retail pharmacies due to its low dispensing frequency and niche market position. Planning ahead and starting refill searches 2-3 weeks before running out is essential. Mail-order pharmacy is the most reliable long-term solution for ongoing supply.
If you're having trouble finding Rivelsa 91 Day at a pharmacy near you, medfinder calls pharmacies in your area on your behalf to locate your prescription. You provide your medication and location — medfinder does the searching and texts you the results.
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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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