Norgestrel / ethinyl estradiol (Cryselle / Low-Ogestrel / Turqoz)

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 potential, as a combination oral contraceptive (birth control pill).

What it is for, in depth

This is one of the oldest combination birth control pills still in use: a fixed daily dose of a progestin and an estrogen taken in a 21/7 cycle. In the label's clinical study, the pregnancy rate was about 1 pregnancy per 100 women-years of use. Although contraception is rarely the reason a Medicare beneficiary takes it, Part D plans list it on their formularies and the CMS utilization data behind this package reflect real fills, including for people covered through Medicare disability or dual eligibility.

How it works

The progestin (norgestrel) and estrogen (ethinyl estradiol) together stop the ovary from releasing an egg, thicken cervical mucus so sperm cannot pass easily, and change the uterine lining.

How it is taken

One tablet by mouth at the same time every day, in the order shown on the pack: 21 days of active tablets followed by 7 days of inactive tablets.

Common side effects

['Nausea', 'Breast tenderness', 'Spotting between periods', 'Headache', 'Mood or weight changes']

Serious warnings

['Blood clots in the legs or lungs, stroke, and heart attack; risk is highest in smokers over 35 (see boxed warning)', 'Liver tumors and liver disease', 'High blood pressure and gallbladder disease']

Boxed warning

Cigarette smoking and serious cardiovascular events: cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. Combination oral contraceptives should not be used by women who are over 35 years of age and smoke.

Who should be careful

['Smokers, especially over age 35, who must not use it', 'People with migraine with aura, uncontrolled high blood pressure, or diabetes with blood-vessel damage', 'Anyone with a history of blood clots, stroke, or heart disease', 'People with undiagnosed abnormal uterine bleeding or liver disease']

Major interactions

["Rifampin, certain seizure medicines, and St. John's wort, which can make the pill fail", 'Lamotrigine, whose levels can fall and reduce seizure control', 'Some hepatitis C drug combinations, which can raise liver enzymes', 'Antibiotics are generally not a problem except for rifampin-class drugs']

Cost and saving notes

Norgestrel/ethinyl estradiol (Cryselle and generics) is an inexpensive generic contraceptive. Under Medicare Part D, contraceptives are covered when prescribed, and this product usually sits on a low tier; many people of Medicare age instead encounter it through Medicaid or other coverage. Extra Help can reduce costs if you qualify. The 2027 Part D out-of-pocket cap is $2,400 for the year, and the Medicare Prescription Payment Plan can spread that cost across the year.

Why it is in its tier

Norgestrel / ethinyl estradiol (Cryselle / Low-Ogestrel / Turqoz) sits on Tier 2 in 61.78% of the plans that list it (3306 of 5351 listing plans). Tier 2 is the generic tier — low copays. The data-visible drivers: It is a generic product, and the CMS dashboard puts its average Part D spending at about $144 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. It is listed by 97.38% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• CRYSELLE (NORGESTREL AND ETHINYL ESTRADIOL) KIT [TEVA PHARMACEUTICALS, INC.] — DailyMed
• MedlinePlus Drug Information

What official patient guides say

Take one tablet by mouth once a day, at around the same time every day, on the days your doctor specifies, following the order of tablets in your pack: the active tablets first, then the inactive tablets, starting a new packet on schedule even if you are still bleeding. Know which brand you are using and how its schedule works, and read the manufacturer's information for the patient carefully. Your doctor will tell you when to start, usually on the first day of your period or the first Sunday after bleeding begins, and you will probably need another method of birth control for the first 7 days. If you vomit or have diarrhea, the pills may not work as well, so contact your doctor; you may be told to use a back-up method for 7 days. If you miss doses, you may not be protected from pregnancy and may need a back-up method for 7 days or until the end of the cycle; every brand has specific missed-dose directions in its patient information, so follow those and call your doctor or pharmacist with questions. Keep all appointments: have a complete physical examination every year, including blood pressure checks, breast and pelvic exams, and a Pap test. Store the tablets in their container, tightly closed and out of reach of children, at room temperature away from excess heat and moisture, not in the bathroom.

Source: MedlinePlus Drug Information

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 0.29519 per unit (CRYSELLE-28 TABLET) — 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, 5,351 list Norgestrel / ethinyl estradiol (Cryselle / Low-Ogestrel / Turqoz) — 97.4% of plans. Most of those plans put it on Tier 2: 3,306 plans, 61.8% of the plans that list it. Other plans place it on Tier 3 (1,492 plans), Tier 1 (418 plans) or Tier 4 (135 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 2; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 2; Aetna Medicare Value Plus (PPO) puts it on Tier 2. 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.