Etonogestrel / ethinyl estradiol (vaginal ring)

How Medicare covers it

Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Prevention of pregnancy in females of reproductive age. Brand name NuvaRing, a flexible vaginal ring used for birth control. For vaginal use only.

What it is for, in depth

NuvaRing is a combination hormonal contraceptive ring used by females of reproductive age to prevent pregnancy. Instead of a daily pill or a weekly patch, one ring is placed in the vagina for 3 weeks and then removed for 1 week, so the user only has to act twice in each 4-week cycle. There is a single ring strength: the flexible, transparent 54 mm ring contains 11.7 mg of etonogestrel and 2.7 mg of ethinyl estradiol and releases on average 0.120 mg/day of etonogestrel and 0.015 mg/day of ethinyl estradiol over the 3 weeks of use. The ring is not made with natural rubber latex, and its exact position in the vagina is not critical for it to work.

How it works

It is a combination hormonal contraceptive (CHC): etonogestrel (a progestin) plus ethinyl estradiol (an estrogen), released slowly from the ring into the vagina. CHCs work mainly by suppressing gonadotropins, which stops ovulation (release of an egg). They also thicken cervical mucus, making it harder for sperm to enter the uterus, and change the lining of the uterus, which lowers the chance of implantation.

How it is taken

One ring is inserted into the vagina and left in place continuously for 3 weeks. It is then removed for a 1-week ring-free break, during which a withdrawal bleed usually occurs, and a new ring is inserted exactly 1 week after the previous one was removed, on the same day of the week and at about the same time. The used ring is placed back in its foil pouch and thrown away in the trash, out of the reach of children and pets (do not flush). If the ring slips out, MedlinePlus advises rinsing it with cool or lukewarm (not hot) water and replacing it within 3 hours.

Common side effects

The most common side effects in the trials (2% or more) were vaginitis (13.8%), headache including migraine (11.2%), mood changes (6.4%), device-related events such as the ring slipping out, discomfort, or a foreign body feeling (6.3%), nausea/vomiting (5.9%), vaginal discharge (5.7%), increased weight (4.9%), vaginal discomfort (4.0%), breast pain, discomfort or tenderness (3.8%), dysmenorrhea (3.5%), abdominal pain (3.2%), acne (2.4%), and decreased libido (2.0%). CHC users also commonly report irregular uterine bleeding and breast tenderness.

Serious warnings

CHCs raise the risk of venous and arterial clots, heart attack, and stroke; stop NuvaRing if a thrombotic event occurs, stop it at least 4 weeks before and through 2 weeks after major surgery, and start it no earlier than 4 weeks after delivery in women who are not breastfeeding. Cases of Toxic Shock Syndrome (TSS) have been reported with vaginal ring use, so signs or symptoms of TSS should be evaluated promptly. Discontinue the ring if jaundice develops. Women with well-controlled hypertension should have their blood pressure monitored and stop the ring if blood pressure rises significantly; women with diabetes or prediabetes should be monitored, an alternate method should be considered for uncontrolled dyslipidemia, significant headache changes should be evaluated, and irregular bleeding or missed periods should be evaluated. Hypersensitivity reactions, including anaphylaxis and angioedema, have occurred.

Boxed warning

WARNING: CIGARETTE SMOKING AND SERIOUS CARDIOVASCULAR EVENTS — Cigarette smoking increases the risk of serious cardiovascular events from combination hormonal contraceptive (CHC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, CHCs, including NuvaRing, should not be used by women who are over 35 years of age and smoke.

Who should be careful

Do not use NuvaRing if you are over 35 and smoke, or are at high risk of arterial or venous clots (past deep vein thrombosis or pulmonary embolism, cerebrovascular or coronary artery disease, thrombogenic heart valve or rhythm disease, or inherited or acquired clotting disorders). It is also contraindicated with uncontrolled high blood pressure, diabetes with vascular disease, headaches with focal neurological symptoms, migraine with aura (or any migraine if over 35), liver tumors or liver disease, undiagnosed abnormal uterine bleeding, pregnancy, a current or past breast cancer that may be hormone-sensitive, or an allergy to any component of the ring, including past anaphylaxis or angioedema.

Major interactions

Drugs or herbal products that induce enzymes such as CYP3A4 — including phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, topiramate, rifabutin, rufinamide, aprepitant, and St. John's wort — can lower hormone levels, make the ring less effective, or cause breakthrough bleeding; use a back-up or alternative non-hormonal method during use and for 28 days after stopping the inducer (a diaphragm or female condom is not recommended as the back-up method with NuvaRing). Strong or moderate CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, ketoconazole, and grapefruit juice may raise hormone levels, and vaginal miconazole nitrate raises etonogestrel and ethinyl estradiol levels by up to 40%; atorvastatin raises ethinyl estradiol levels by about 20–25%. HIV/Hepatitis C protease inhibitors and non-nucleoside reverse transcriptase inhibitors can raise or lower hormone levels. NuvaRing lowers lamotrigine levels, which may reduce seizure control, and women on thyroid hormone replacement may need a higher thyroid dose. It must not be used with Hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, because of the risk of liver enzyme (ALT) elevations.

Cost and saving notes

If this drug is covered under your Medicare Part D plan and the cost is high, you can ask your plan for a tier exception to pay a lower cost share. If you have limited income, Extra Help (the Part D Low-Income Subsidy) can lower your Part D premiums and drug costs. In 2027, your total yearly out-of-pocket spending on Part D drugs is capped at $2,400, and you can ask your plan to spread those costs out in monthly payments through the Medicare Prescription Payment Plan.

Why it is in its tier

Etonogestrel / ethinyl estradiol (vaginal ring) sits on Tier 3 in 77.31% of the plans that list it (4248 of 5495 listing plans). Tier 3 is the preferred brand tier — mid-level copays or coinsurance. The data-visible drivers: It is sold both as a brand product and in generic form, and the CMS dashboard puts its average Part D spending at about $541 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. It is listed by 100.0% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• NUVARING (ETONOGESTREL AND ETHINYL ESTRADIOL) INSERT, EXTENDED RELEASE [ORGANON LLC] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Estrogen and Progestin (Vaginal Ring Contraceptives)

What official patient guides say

With the NuvaRing, daily life runs on a simple monthly rhythm: you place one flexible ring in the vagina and leave it in place for 3 weeks, then take it out for a 1-week break, when a withdrawal bleed usually happens. After exactly 1 week, put in a new ring on the same day of the week and at about the same time, even if you have not stopped bleeding, and repeat the cycle with a fresh ring each month. Check that the ring is still in place, especially before and after intercourse, because it can slip out when removing a tampon, during intercourse, or during a bowel movement. If a NuvaRing slips out, rinse it with cool or lukewarm — not hot — water and put it back within 3 hours; if it is broken, throw it away and use a new ring. Store rings at room temperature, away from direct sunlight, heat, and moisture — do not refrigerate or freeze them — and throw a used ring away in its foil pouch in the trash, never down the toilet.

Source: MedlinePlus — Estrogen and Progestin (Vaginal Ring Contraceptives)

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 45.07233 per unit (ELURYNG VAGINAL RING) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-08

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Etonogestrel / ethinyl estradiol (vaginal ring) — 100% of plans. Most of those plans put it on Tier 3: 4,248 plans, 77.3% of the plans that list it. Other plans place it on Tier 2 (482 plans), Tier 4 (394 plans) or Tier 1 (371 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 3; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 3; Aetna Medicare Value Plus (PPO) puts it on Tier 3. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.