Comprehensive medication guide to Twirla including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0 copay under most ACA plans; $25/month with manufacturer savings card; prior authorization may be required if plan prefers Xulane.
Estimated Cash Pricing
$250–$290 per month retail; as low as $200–$210 with discount cards, or ~$50/month through select telehealth platforms.
Medfinder Findability Score
55/100
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Twirla is a prescription combined hormonal contraceptive (CHC) patch that prevents pregnancy. It contains two hormones — Levonorgestrel (a progestin) and Ethinyl Estradiol (an estrogen) — delivered through the skin via a small, round transdermal patch using Skinfusion® adhesive technology.
Twirla is FDA-approved for the prevention of pregnancy in women with a BMI less than 30 kg/m². It is applied once weekly for 3 weeks, followed by one patch-free week, making it a convenient non-daily contraceptive option. The patch is applied to clean, dry skin on the buttock, abdomen, or upper torso (not the breast).
Important: Twirla is contraindicated in women with a BMI of 30 kg/m² or higher due to reduced efficacy and increased risk of venous thromboembolism (VTE). Women over 35 who smoke should not use Twirla.
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Twirla delivers Levonorgestrel and Ethinyl Estradiol continuously through the skin into the bloodstream. These hormones work together to prevent pregnancy through three mechanisms:
The patch delivers a lower dose of estrogen (30 mcg ethinyl estradiol per day) compared to the other contraceptive patch Xulane (35 mcg), which may result in fewer estrogen-related side effects for some patients.
Transdermal patch — patch
120 mcg levonorgestrel / 30 mcg ethinyl estradiol per 24 hours (each patch contains 2.60 mg LNG and 2.30 mg EE total)
Twirla scores a 55 out of 100 on our findability scale, meaning it can be moderately difficult to locate. As a single-source brand-name product made by the small manufacturer Agile Therapeutics, Twirla is not stocked at every pharmacy. There is no generic version available, and its limited distribution network means you may need to call around or use a specialty pharmacy. While Twirla is not on the FDA drug shortage list, patients have reported difficulty finding it in stock at local retail pharmacies since its 2020 launch.
If your local pharmacy doesn't carry Twirla, ask them to order it or try a larger chain pharmacy. You can also use Medfinder to locate pharmacies that have it in stock near you.
Twirla can be prescribed by a variety of healthcare providers, including:
Twirla is also available through telehealth platforms, making it accessible without an in-person visit. Some telehealth services like Pandia Health offer Twirla prescriptions and delivery for approximately $50/month.
No, Twirla is not a controlled substance. It does not have a DEA scheduling designation. As a hormonal contraceptive, it does not carry the abuse or dependence potential associated with controlled medications. You can get refills without the additional restrictions that apply to scheduled drugs.
Serious side effects (rare but important): venous thromboembolism (blood clots), stroke, heart attack, liver problems, gallbladder disease, and hypertension. Seek immediate medical attention if you experience severe leg pain, sudden shortness of breath, chest pain, sudden severe headache, or vision changes.
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Xulane (Norelgestromin/Ethinyl Estradiol patch)
the other contraceptive patch on the market, containing a slightly higher estrogen dose (35 mcg EE). Available as a generic, making it significantly cheaper. No BMI restriction in labeling.
Zafemy (Norelgestromin/Ethinyl Estradiol patch)
another generic version of the Ortho Evra contraceptive patch, similar to Xulane.
NuvaRing (Etonogestrel/Ethinyl Estradiol vaginal ring)
a flexible vaginal ring worn for 3 weeks, then removed for 1 week. Generic version (EluRyng) available.
Combined oral contraceptive pills
daily birth control pills containing Levonorgestrel/Ethinyl Estradiol. Many generic options available at very low cost ($0–$20/month). Require daily adherence.
Prefer Twirla? We can find it.
CYP3A4 inducers
moderate(Rifampin, Phenytoin, Carbamazepine, Phenobarbital, Topiramate, Felbamate, Oxcarbazepine, Bosentan) — may decrease contraceptive effectiveness, increasing pregnancy risk
St. John's Wort
moderatemay decrease contraceptive effectiveness; avoid concurrent use
HIV protease inhibitors and NNRTIs
moderatemay alter hormone levels in either direction
Hepatitis C drugs containing Ombitasvir/Paritaprevir/Ritonavir
moderatecontraindicated due to risk of liver enzyme (ALT) elevations
Lamotrigine
moderateTwirla may decrease Lamotrigine levels, potentially increasing seizure risk
Thyroid hormone replacement (Levothyroxine)
moderatedose adjustments may be needed
Twirla offers a convenient once-weekly contraceptive option with a lower estrogen dose than the competing Xulane patch. However, its availability can be a challenge — as a brand-only product from a small manufacturer, it's not stocked everywhere and costs $250–$290 per month without insurance.
The good news: most commercial insurance plans cover contraceptives at $0 copay under the ACA, and Twirla's manufacturer savings card can bring costs down to as low as $0 for the first month and $25/month thereafter. If you're having trouble finding Twirla in stock, use Medfinder to search pharmacies near you, or ask your pharmacy to special-order it.
Keep in mind that Twirla is not recommended for women with a BMI of 30 or higher. If cost or availability is a barrier, talk to your doctor about Xulane or generic oral contraceptives as alternatives.
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