packet of birth control pills with one missing

(Updated 2022) Birth-control pills come in what looks like a bewildering collection of names for the lay person. Tri-Sprintec, Tri-Lo-Sprintec? Why do some have 21, 24, 28 in their names? Yikes. And … what do they cost?

Here’s a handbook on birth-control pill types. For further price information, see our preceding posts about birth-control pricing here (how much do they cost?) and here (chain stores vs. indies).

For many common pills, the combination of ethinyl estradiol and a progestin inhibits ovulation and influences the cervical mucus and endometrium to discourage implantation. A woman’s cycle is usually 28 days, so the number of pills is generally based on that.

A doctor explains

A friend who’s an adolescent medicine specialist writes: “It used to be simple in the days before generics, but now the number of different names is mind-numbing.  But the good news is that prices of the generics are much lower!   I often get calls from patients double-checking to make sure they’ve gotten the correct pill after the pharmacy dispenses a brand they’ve never heard of.

women's health oral contraceptive pill article

“I generally write prescriptions using the brand name but specifying that a generic substitute is OK.  That’s better than writing for the generic brand because the different brands seem to come and go as pharmacies and insurance companies deal with different manufacturers.  Some patients do report different side effects with different generics, and there are tons of posts on the web by women about their preference for one or another.  I assume the differences are related to the inactive ingredients or variations in hormone content that is within the FDA requirements but enough different for occasional patients to notice.

“The numbers following the name of a birth control pill usually refer to the amount of the synthetic hormones, progesterone followed by estrogen, separated by a slash (/).  Almost all U.S. birth control pills use ethinyl estradiol for the estrogen, but the amount varies from 15 to 35 micrograms (a few 50 mcg pills exist but are used for specific indications, not routine birth control).  There are a handful of different progesterones used in different pills. They include norethindrone, norgestrel, levo-norgestrel, norgestimate desogestrel, drospirenone and ethynodiol.  The different progesterones have different side effect profiles, so doctors may recommend a particular pill based on the patient’s particular situation – some help with excessive bleeding, others with acne or excess body hair, etc.

“Most pills are 21 day monophasic pills, meaning they are packaged with the same dose for 21 days. During a week of placebo pills (containing no active medication) or no pills at all, hormone levels drop so a menstrual period occurs.  The same brand may be packaged in a 21- or 28-day pack. In that case, the number 21 or 28 will occur after a dash in the name. A few brands now include a much lower dose of estrogen during the last week in a pack or an insignificant amount of iron (Loestrin FE)  or some folate (Vitamin B in Beyaz).

“I avoid using the 21-day packs because many patients forget to restart their pills after a week.  With the pills packaged with placebo pills, they take a pill every single day, starting a new pack immediately after finishing the previous pack.

“A few pills are packaged with 24 days of the active pill and only 4 placebo pills.  As a result, the menstrual period is shorter.  There are also a few extended cycle preparations, with 84 active pills followed by 7 placebo pills, so menstruation occurs every  3 months.

“There are also triphasic pills which are packaged with slightly different concentrations of hormone throughout the month.  They are generally in 28-days pack.  One of the most popular pills is Ortho-Tri-Cyclen. The triphasics generally have ‘tri’ in their names or have 7/7/7 in the name.”

She adds: “I love smalltown, individually-owned pharmacies, but many of my patients use Target for Orthocylen/Sprintec/Mononessa/Prevafem or their Tri sisters for $9/pack.  There aren’t many Walmarts around, so I haven’t had experience with them, but their website does list it on their inexpensive med list.  Both companies’ websites have long lists of generic drugs available for $4-12/month supply and even bigger discounts for 90-day supply.”

MedScape has a lot of good information about all kinds of prescription medications.

LoEstrin, Junel, Microgestin and other names

Here’s an example: LoEstrin is made by Teva Pharmaceuticals. It comes in several different generics, including Microgestin and Junel.

A common generic is Junel 1.5-30, meaning 1.5 mg norethindrone acetate) and 30mcg ethinylestradiol.  There’s also Junel 1-20, which has 1 mg norethindrone acetate, and 20 mcg ethinyl estradiol. 

Junel Fe/1.5-30 (Junel Fe/1-20) is the same prescription, but it has 7 iron pills, so the woman takes 21 active pills and then 7 iron pills.

For Junel, Microgestin, and Loestrin, we know of Junel 1.5/30, Junel 1/20, Junel Fe 1.5/30, Junel Fe 1/20.

Microgestin 1.5/30, Microgestin 1/20, Microgestin Fe 1.5/30, Microgestin Fe 1/20,

Loestrin Fe, Loestrin 21 1.5/30, Loestrin 21 1/20, Loestrin 24 Fe, Loestrin Fe 1.5/30, Loestrin Fe 1/20.

Loestrin 24 Fe, then, has 24 days of active pills and four days of iron in the placebo pills.

A note of caution: When you’re buying, you might find that some independent or chain pharmacies carry one generic, while some carry another. This can be confusing (“I’ve been taking Microgestin, so why are you giving me Junel?”). It can also be true, as our doctor friend notes, that certain pills work better for some women than others, even though both are considered equivalent generics. And then you will encounter the term “formulary,” as in — when you try to fill a prescription at a different pharmacy or on a different insurance plan — you are told “that’s not on our formulary” or “we don’t carry that.” In other words, pay full price or go somewhere else — or choose our club-discount card, if you’d like.

Some pills use drospirenone as the first ingredient. Yasmin, Ocella, Zarah, Safyral, Syeda all have  3 mg drospirenone and 30 mcg of ethinyl estradiol  for 21 days, then one inert tablet  for 7 days.Their cousins, Yaz, Beyaz, Gianvi, Loryna and Vestura have  3 mg drospirenone and 20 mcg ethinyl estradiol for 24 days, then one inert tablet  for 4 days. Source: Medscape.

Ortho-Tri-Cyclen has several generics: Trinessa and Tri-Sprintec. But Ortho-Tri-Cyclen Lo, as far as we can tell, has no generic yet; MedScape’s dictionary of drugs, again, is our source for that.

Confused yet? Don’t get us started on how a brand-name drug becomes a generic, or how a brand-name drug that is eligibile for generic manufacture might suddenly become a slightly different drug, and therefore not something that can be turned into a generic. We wrote about this in this blog post: for example, when Yaz, the popular pill, became eligible for generic manufacture, then acquired an added chemical, the vitamin folic acid, which is important for women planning to get pregnant to overcome spinal bifida and other birth defects. So Yaz became Beyaz.

We did an interactive map asking people how much they were paying for birth-control pills. It’s no longer active, but this is what it looked like. We used a collection of 600-some cash or self-pay prices at New York area pharmacies that we collected in April-May 2013, and the graphics team at WNYC made the interactive.
price of birth control pills WYNC MAP

Further information? Here’s the FDA Web site. And here’s the Mayo Clinic Drugs and Supplements site.

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Want still more information? There’s advice about buying prescriptions on our reference page on the topic. Also, see our preceding posts about birth-control pricing here (how much do they cost? $9 to $63? Really?) and here (chain stores vs. indies).