Readers speak out on status of the Pill
While combined oral contraceptives (OCs) remain a leading choice for contraception, other methods are making their mark. About 38% of respondents to the 2011 Contraceptive Technology Update Contraception Survey said more than half of their patients use OCs, a drop from 2010's 42% level.
Sharon Carlisle, CNM, lead clinician at Planned Parenthood of Southwest and Central Florida in Tampa, FL, says the number of patients leaving her office using birth control pills has definitely changed in the last year. More women are choosing the vaginal contraceptive ring (NuvaRing, Merck & Co., Whitehouse Station, NJ), and many more women are selecting intrauterine contraception, Carlisle reports. Results of the 2011 CTU survey show that 91% of respondents say their facility is offering NuvaRing, with 78% carrying the contraceptive patch (Ortho Evra, Ortho Women's Health & Urology, Raritan, NJ).
About 42% of respondents say their prescription of extended or continuous regimen pills has increased, while about 49% say their practice has remained steady.
Patricia McKenzie, NP, director of women's health at Waianae Comprehensive Health Center in Waianae, HI, says her prescribing of such regimen pills has increased only slightly as most insurance companies and Medicaid do not cover continuous use. Medicaid patients can only pick up one pack of pills per 28 days, she states.
There are five 30-mcg dedicated extended regimen pills: Seasonale, Seasonique, and Jolessa, all from Teva Pharmaceuticals, North Wales, PA, and Quasense and Amethia from Watson Pharmaceuticals, Morristown, NJ. LoSeasonique from Teva Pharmaceuticals is a 20-mcg extended regimen pill. The Food and Drug Administration issued approval in December 2011 to Watson's Amethia Lo as a generic equivalent of LoSeasonique, with approval given in October 2011 to Baltimore-based Lupin Pharmaceuticals' generic version of the same pill. Two options are available in dedicated continuous pills: Lybrel, a 20-mcg pill from Wyeth Pharmaceuticals of Philadelphia, and Amethyst, its generic equivalent from Watson, launched in 2011.
Which pill to use?
Ortho Tri-Cyclen Lo (Ortho-McNeil Pharmaceutical; Raritan, NJ) continues as the no. 1 choice as the top non-formulary pill for young women, a spot it has maintained since 2008. (See graphic, below.) However, when formulary rules dictate which pill to use for this age category, respondents to the 2011 survey named Loestrin from Teva Pharmaceuticals. Ortho Tri-Cyclen, a 35-micg phasic pill from Ortho-McNeil Pharmaceutical, was the 2010 formulary leader. Alesse (37%) remains in its top spot as the pill of choice for older women, followed by last year's leader, Loestrin (22%).
Which pill do clinicians choose when it comes to prescribing an OC for a 42-year-old patient? About 40% of patients named Alesse, a 20-mcg pill from Wyeth, which kept it in its top spot from last year. (See graphic below.)
Alesse also continues as the leading option for women who have experienced nausea when using previous pills, with 49% naming it as the top pill in the 2011 survey. The pill has been named the top choice in this category since 1999.
Generics gain ground
Budget constraints are pinching the pocketbooks at many family planning facilities. Three-quarters of 2011 survey respondents say their facilities have stepped up use of generic oral contraceptives in the past year due to tightened budgets. No doubt use of generics has risen; the price differential between generic and brand-name products can be as much as 70%.1
"Generics have helped to keep our costs down and still be able to provide on-site OCs for our most common types of pills" says Donna Gray, NP, a nurse practitioner at Wyoming County Health Department in Silver Springs, NY. "It does make it hard to keep updating our inventory with different pills every time I order."
Reference
- American College of Obstetricians and Gynecologists. ACOG Committee Opinion Number 375: Brand versus generic oral contraceptives. Obstet Gynecol 2007; 110:447-448.
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