Surprising Facts Every Woman Should Know About Nexplanon Cost

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Medically reviewed by, Russell Braun RPH

Nexplanon (Etonogestrel) is a new option in birth control. Instead of pills that you have to remember to take, the drug is implanted under the skin of your upper arm. While this seems like a great way to ensure you don’t forget to take a pill everyday, is the cost worth it?

The single rod that is about and inch and a half long, releases progestin which is a non estrogen form of birth control. It provides protection from pregnancy for up to three years once implanted.

Does it require surgery?

Nexplanon is different than typical birth controls pills that your doctor would write a prescription for. A minor procedure is required, but it is not a surgery.

The drug will be placed in your arm during a simple procedure in the office. Special training is required for your doctor who will use a local anesthetic to numb the area. Then an applicator will be used to place the Nexplanon under your skin.

You will need to wear a bandage for three to five days after the procedure. It is a relatively simple process.

Keep in mind the procedure itself will be a part of the cost to you. If your insurance covers it then you may have no out of pocket expense. However, if you have not met your deductible you could have to pay for the procedure in addition to the drug

Can you get pregnant with nexplanon?

Aside from abstinence, no form of birth control is 100% effective. That being said Nexplanon is very good at preventing unwanted pregnancy.

Click here for pregnancy tests

It is >99% effective for up to three years. The manufacturer data shows that less than 1 woman out of 100 would become pregnant who use Nexplanon for one year.

Is Nexplanon good for 3, 4 or 5 years?

The Food and Drug Administration (FDA) approved Nexplanon for three years of use. The idea of the implant is it gradually releases etonogestrel hormone into the body. After three years the amount of etonogestrel available in the implant is not enough to maintain levels that would consistently prevent pregnancy.

There have been studies done that look at if the implant might be good for longer than 3 years. In fact, one study found that the implant would be good for up to 2 years beyond the FDA label for Nexplanon.

This would make the implant good for up to 5 years. The cost effectiveness of Nexplanon is much more attractive the longer it can be used.

However, at this point you should still only use Nexplanon for 3 years!

The cost of unplanned pregnancy is greater than the dollars saved by trying to stretch out your birth control. Many think Merck the manufacturer of Nexplanon will look to expand it’s usefulness timeframe with the FDA.

Important points

Before looking at the costs, keep a few things in mind.

  • This is an implant, if you experience side effects you can’t do anything about them unless you get Nexplanon removed.
  • Many women end up with no periods, however that is after the first 3-4 months where bleeding can be heavy and or irregular.
  • Progestin only birth control can cause acne.

The book Beyond the Pill is a great way of looking at birth control options from a different perspective. If you are thinking of getting a Nexplanon implant, but not sure due to the cost, this book may help you decide.

Click here to see Beyond The Pill

Nexplanon cost

Nexplanon has three costs that you need to keep in mind.

  1. Drug costs
  2. Cost of the procedure to place the implant in your arm
  3. Implant removal costs

Drug cost

According to GoodRx, the maximum price that a consumer with or without insurance should pay for this drug is $889.

Typically, you would not obtain this drug from a pharmacy. The doctor who will place the implant will normally have the drug.

Cost of procedure

Prices vary based on the type of practitioner who is inserting the implant and what area of the country you live in.

The normal price range if you were to pay cash is $0-$1,300 according to Planned Parenthood. That cost would include the drug and the procedure. If you are uninsured you should ask your doctor if they can give you a price adjustment. Womens clinics and family planning facilities may also offer better prices.

Cost of implant removal

The removal of the implant can range in cost from $250-$350. Make sure you talk to the doctor about the cost of the removal prior to starting Nexplanon.

This bill for removal is not something you can avoid, you must get the implant taken out. Asking about this cost before starting Nexplanon could help you avoid a surprise medical bill.

Is Nexplanon covered by my insurance?

Drugs are typically covered by insurance under the part of the benefit called pharmacy benefit. An example would be part D of Medicare, which is the pharmacy benefit. Office visits and procedures that are completed by your doctor are typically covered under what is called the medical benefit.

In certain situations where drugs are administered by the prescriber directly those drugs may be billed under medical benefit as well. Most insurers will cover Nexplanon in this manner, under the medical benefit.

Follow these steps to determine if Nexplanon will be covered under the medical or pharmacy benefit.

  • Call the phone number listed on the back of your medical benefit card.
  • Ask the customer service person if Nexplanon is covered under your medical benefit if the doctor receives the medication and does the procedure during an office visit.
  • If they state Nexplanon is not covered under medical benefit, ask if they can tell you if it is covered via pharmacy benefit
  • You may have to call the number on the back of your prescription drug card at this point.
  • If covered under that pharmacy benefit make sure you understand if it will be shipped to the doctor or what needs to be done to ensure coverage.
  • Prior Authorization may be required to be complete by your doctor, make sure to confirm if will be needed or not.

Merck offers a clinical training program that your doctor must complete before they an administer Nexplanon. Make sure your doctor has completed this training so you do not have to go elsewhere to seek treatment.

Obamacare

Obamacare also known as the Affordable Care Act (ACA) enacted a provision that requires health insurance plans cover certain birth control options. In fact, they must cover all FDA approved birth control options without charging a copayment or coinsurance. This applies even if you have NOT met your deductible.

This is a terrific benefit to patients. Being able to receive an almost 100% effective birth control option at no cost is a no brainer!

Insurance plans do have the option to prefer you get a generic over a brand product. However, since Nexplanon is not available generically the ACA says they must cover it free of charge to the patient. The patent on Nexplanon does not expire until 2027, which is the earliest a generic could enter the market.

Grandfathered health plans

There is a catch. Any health insurance plan that was in existence prior to the ACA, does not have to follow the same rules. Therefore, they may be able to deny coverage of Nexplanon for other forms of birth control.

These type of plans are decreasing in numbers. The main reason is that if they make significant changes to the plan, they will not longer be able to have the grandfather protection. Significant changes would be to things such as the deductible amount, or significantly raising patient out of pocket limits.

Title X Clinics

Obamacare will help patient with insurance, but what about if you do not have insurance? The original idea behind Obamacare was to make it illegal to not have health insurance and thus every woman should have access to some form of birth control.

Because of shifting political climates changes that have occurred due to Obamacare. Now, there is no longer a requirement to have insurance. So, how can you save money on Nexplanon if you do not have insurance?

This is where Title X clinics come in. These Title X clinics receive federal grant funding and are dedicated solely to family planning for preventative health services. As a result, they will offer pricing that is based on your income.

What other types of birth control cost

Birth control pills (Many different brands)

  • Hundreds of options available
  • Not as effective at preventing pregnancy as Nexplanon
  • Do have many with generics
  • Can find $4 generics for 30 day supply*

Vaginal ring (Nuvaring)

  • Only needs to be replaced once per month
  • Not as effective at preventing pregnancy as Nexplanon
  • No generic available
  • Cash price $169 for a 30 day supply*

Birth control patch (Xulane)

  • Only needs to be changed one time per week
  • Not as effective at preventing pregnancy as Nexplanon
  • No generic available
  • Cash price $112 for 30 day supply*

IntraUterine Device (IUD) Hormonal

  • Needs to be placed by a medical professional, good for 3-6 years
  • Nearly as effective at preventing pregnancy as Nexplanon
  • Several brands now available (Mirena, Skyla, Liletta, Kyleena)
  • Similar to Nexplanon these may be covered in full by ACA
  • Cost for Mirena $952 for 5 years, plus any costs of procedure to implant or remove*

IntraUterine Device (IUD) Non Hormonal

  • Is completely free of hormones, uses copper which is toxic to sperm
  • Lasts for up to 10 years
  • ParaGard is only brand available
  • Similar to Nexplanon may be covered in full by ACA
  • Cost for ParaGard $809 for 10 years, plus any costs of procedure to implant or remove*

Birth control shot

  • Shot is given once every 3 months
  • Not as effective at preventing pregnancy as Nexplanon
  • Depo-Provera has generic alternative available
  • Cash price is $40.88 for 3 month supply*

*Prices shown are per GoodRx

Nexplanon cost vs. other types of birth control

With insurance

For patients with insurance that covers the drug and procedure in full this seems like an easy decision. Nexplanon is a highly effective birth control, at low or no cost and can be removed allowing women to become pregnant almost immediately if desired.

Similarly, other FDA forms of birth control are also paid for per the ACA. Therefore, you should determine which drug will work the best, has fewest side effects and makes the most sense for your lifestyle.

Without insurance

Despite a $1600 cost for drug, implanting procedure and removal, the long duration of effect reduces the cost over time.

  • 3 years comes out to $45 per month
  • 4 years comes out to $33 per month
  • 5 years comes out to $27 per month

You should talk to your doctor if they feel that it is safe for you to use the implant past three years.

These monthly prices are higher than some other options detailed above. If you do not have insurance you should look for assistance via Title X clinics as well.

You can also ask Merck for help

The Merck Patient Assistance Program is available for uninsured women. To qualify, you must attest to having special circumstances around income. If eligible you may receive the medication free of charge.

Does Nexplanon cause weight gain?

For more information on Nexplanon and weight gain check out these statistics.

Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!

Share your story

Have you tried Nexplanon? Also, please share how it worked for you? Please chime in below with your comments and thoughts.

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