What to do if you lose birth control coverage

In this article:

• Possible reasons why your insurance stopped covering birth control
• How much is birth control without insurance?
• What to do if your insurance won’t cover birth control
• Affordable birth control options
• Compare affordable birth control options
• How to save on birth control without insurance

In this article

• Possible reasons why your insurance stopped covering birth control
• How much is birth control without insurance?
• What to do if your insurance won’t cover birth control
• Affordable birth control options
• Compare affordable birth control options
• How to save on birth control without insurance

A health insurance company may change its formulary (the list of drugs it will cover) at any time, and sometimes these changes affect prescription contraceptives. The average woman tries more than three birth control methods in her lifetime, and losing birth control insurance coverage may mean trying yet another. It can be frustrating to trade a trusted contraceptive for an alternative that may be unfamiliar or less tolerable, but there’s good news: you may not have to switch your birth control at all. Let’s take a look at what you can do when your insurance stops covering birth control.

Possible reasons why your insurance stopped covering birth control

Your insurance probably stopped covering your specific birth control because a lower-cost generic version became available. Insurance companies are required by law to cover generic FDA-approved contraceptives. More specifically, they must cover at least one contraceptive in each category. There isn’t much wiggle room for dropping birth control coverage for any other reason. 

“Insurance companies are always trying to manage expenses, so if a generic version of a name-brand product becomes available, they may encourage people to switch to it,” says James Lyons, a hospitalist and physician in Austin, Texas, and a medical consultant at Synergy Houses. “Sometimes it’s also about negotiations between insurers and drug companies. In some cases, coverage might be limited due to religious or moral objections. That is less common, but it does still happen.” 

It’s true that payers defined as “houses of worship” don’t have to follow birth control coverage laws in their health plans. In addition, some health plans were grandfathered in when the laws were enacted in 2012 and may continue to deny coverage for birth control products. 

However, Dr. Lyons says most insurance plans cover some kind of birth control. “It’s not usually done in a way that means all birth control is removed. It’s more common to see specific brands or types no longer covered. It can be frustrating if someone has been doing well on a particular brand.” 

Alyssa Small Layne, MD, a D.C.-based board-certified OB-GYN and the founder of Junie, has had similar experiences. “I’ve never seen an insurance company drop coverage for all forms of contraception, but they often change which formulations, brand names, medications, or devices they will cover.”

“I’ve been in practice for eight years and I’ve learned not to tell patients I’m prescribing a particular type of birth control pill, for example, because I have to wait and see what insurance will cover,” she says.

How much is birth control without insurance?

The cost of birth control without insurance varies considerably. Oral contraceptive pills tend to be the most affordable and cost about $35–$270 for a one-month supply without insurance or discounts. Intrauterine devices (IUDs) are the most expensive prescriptions, ranging from around $1,150–$1,600. The arm implant Nexplanon is also an expensive option, averaging over $1,500 per implant.

When comparing birth control prices, keep in mind the average lifespan of each option. For example, birth control patches and pills require a monthly refill (or every three months if your insurance pays for a three-month supply), but IUDs last three to 10 years, depending on the brand. Arm implants last for about three years, diaphragms expire after two years, and birth control shots are injected by a healthcare provider every three months. 

If you don’t have insurance or your insurance stopped covering birth control, consider whether it’s worth paying a higher upfront cost to save money over time. Plus, IUDs and implants are the most effective birth control options, rated about as effective as sterilization by the American College of Obstetricians and Gynecologists. 

What to do if your insurance won’t cover birth control

If your insurance plan won’t cover your birth control, don’t wait to take action. You may be able to continue taking your birth control uninterrupted—and for free— after a couple of phone calls.

1. Contact your insurance company

When you lose birth control coverage, your first phone call should be to the insurance company. Find out exactly why the prescription is no longer covered. This information can help you and your healthcare provider decide how to proceed.

2. Ask your healthcare provider to submit an exception request

As soon as possible, tell your healthcare provider that there’s been a change in your prescription coverage. They can submit an exception request on your behalf. 

An exception request asks the insurance company to cover a prescription that isn’t normally covered. The request must include information about why the medication is medically necessary and why alternatives aren’t appropriate. 

Federal law requires most insurance plans to cover at least one FDA-approved birth control method in each category, as long as your healthcare provider considers it medically appropriate. If your preferred prescription is not covered, approval of the exception request will depend on your specific plan. If it’s prescribed by an in-network provider, birth control has to be free—no copay or coinsurance required. But because laws are complex, there may be exceptions.   

3. Consider paying out-of-pocket temporarily

Consider temporarily paying out of pocket while you wait for a decision about your exception request. You may be able to get reimbursed by the insurance company if they grant the exception request, so save your receipts. 

Paying out-of-pocket for your tried-and-true birth control may be more affordable than you think, and it may be feasible long-term. Ask your pharmacist how much it costs, and keep reading to find out how you can save even more.

4. Use a backup method in the meantime 

In the best-case scenario, your exception request will be granted quickly. But there may be delays, and if your healthcare provider decides to start you on a new birth control method, you may have to wait for it to reach full effect. Use an effective backup method to prevent pregnancy in the meantime. You can talk to your healthcare provider about which backup method is best for you.

Over-the-counter birth control options include:

• Male condoms: 87% effective
• Female condoms: 79% effective

You can also buy spermicide over-the-counter, but it’s most effective when used with a barrier method like a condom, cervical cap, or diaphragm. Diaphragms and cervical caps require a prescription to ensure you get the correct size. 

Pull-out (withdrawal) and fertility-tracking are the least effective birth control methods, but the American College of Obstetricians and Gynecologists says they can prevent 77%–80% of pregnancies when done correctly.

Emergency contraception is not intended for use as routine birth control, but it may be an option in certain cases, such as when a condom breaks or after unprotected intercourse, including cases of sexual assault. It is more effective the sooner it’s used.

5. Discuss alternatives with your healthcare provider

Health insurance companies typically cover some form of birth control, even if name-brand options have been dropped from their formularies. Your healthcare provider can help you sort through the covered options and suggest one to try next.

To find out which contraceptives are still covered by your insurance plan, look up the latest version of the formulary. If you have an online account with your health insurance provider, log in to access this document. Otherwise, call the customer service number on the back of your insurance card to talk to a representative.

Affordable birth control options

Here’s a look at some of the most affordable prescription birth control options for out-of-pocket payers.

Compare affordable birth control options
Drug name	Type of birth control	Cost without insurance*	SingleCare cost*	How to save
Levora (levonorgestrel-ethinyl estradiol)	Pill	$35 per 1 disposable pack of 28, 0.15 mg/30 mcg tablets of name-brand Levora	$5 per 1 disposable pack of 28, 0.15 mg/30 mcg tablets of generic levonorgestrel-ethinyl estradiol	Get coupon
Tri-Sprintec (norgestimate-ethinyl estradiol)	Pill	$65 per 1 disposable pack of 28, 0.18-35/0.215-35/0.25-35 mg-mcg tablets of brand-name Tri-Sprintec	$6 per 1 disposable pack of 28, 0.18-35/0.215-35/0.25-35 mg-mcg tablets of generic norgestimate-ethinyl estradiol	Get coupon
Vienva (levonorgestrel-ethinyl estradiol)	Pill	$44 per 1 disposable pack of 28, 0.1 mg/20 micrograms (mcg) tablets of name-brand Vienva	$7 per 1 disposable pack of 28, 0.1 mg/20 micrograms tablets of generic levonorgestrel-ethinyl estradiol	Get coupon
Apri (desogestrel-ethinyl estradiol)	Pill	$100 per 1, 28-day pack of name-brand Apri	$10 per 1, 28-day pack of generic desogestrel-ethinyl estradiol	Get coupon
Depo-Provera (medroxyprogesterone acetate)	Injection	$136 per 1, 1 mL of 150 mg/mL syringe of name-brand Depo-Provera	$31 per 1, 1 mL of 150 mg/mL syringe of generic medroxyprogesterone acetate	Get coupon
Nuvaring (etonogestrel-ethinyl estradiol)	Vaginal ring	$236 per 1 ring	$40 per 1 ring	Get coupon
Femcap	Cervical cap	$97 per 1 cap	$73 per 1 cap	Get coupon
Caya	Diaphragm	$112 per 1 diaphragm	$77 per 1 diaphragm	Get coupon
Xulane (norelgestromin-ethinyl estradiol)	Patch	$266 per 1 box of 3, 150-35 mcg/24 hr patches	$77 per 1 box of 3, 150-35 mcg/24 hr patches	Get coupon
Twirla (levonorgestrel-ethinyl estradiol)	Patch	$291 per 3, 1 patch weekly boxes	$202 per 3, 1 patch weekly boxes	Get coupon

*Average cost at time of publication. Drug prices fluctuate and vary by pharmacy and location.

How to save on birth control without insurance

Whether you’re looking for prescription or over-the-counter birth control products, a free SingleCare prescription discount card can help you save up to 80% at your preferred pharmacy. You can use these coupons if you have health insurance, but you can’t combine SingleCare savings with insurance—you can use one or the other. 

Here’s how it works: 

1. Search for a drug or product via the SingleCare search bar.
2. Compare prices at pharmacies near you.
3. Click the “Get Coupon” button next to your preferred pharmacy.
4. Create a free SingleCare account to save this coupon, or print a copy for future reference. You can also email or text a copy to yourself.
5. Make sure your healthcare provider sends the prescription to your chosen pharmacy.
6. Show the coupon to the pharmacy staff when picking up your prescription.

Some birth control options, like IUDs, can still be prohibitively expensive with discounts. Dr. Layne suggests contacting local organizations to see if you qualify for low-cost birth control. “Certain clinics and Planned Parenthood locations offer highly effective contraception on a sliding scale. Meaning if you have a lower income, the price you pay for an IUD is lower,” she says.