Patch Over Pill

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Women have fallen in love with estrogen patches instead of pills for hormone replacement therapy, yet are continually stung by the cost. There is now a generic option for an estrogen patch that has become a game changer, so let’s get to know our options.

Estradiol is used to prevent osteoporosis and relieve symptoms associated with menopause. Estradiol is the principal intracellular human estrogen and is available in many dosage forms, including transdermal patches, topical creams, gels or sprays, vaginal creams, oral tablets, vaginal rings, and injections.

Why do patients and doctors love estrogen patches?

1. Transdermal (a patch worn on the skin) administration of estradiol avoids first-pass metabolism. This means the liver and gut don’t have to do much work or feel the strain.

2. Estrogen patches allow for continuous delivery of the hormone.

3. Estradiol is minimally metabolized in the skin, so higher estradiol blood levels are present which more closely mimic natural premenopausal concentrations.

4. Estrogen patches have a short half-life so levels of estradiol return to normal within 4 to 8 hours of patch removal.

Estradiol patches are available in different doses and until recently the options were all expensive. Now Climara patch is available as a generic estradiol patch. Vivelle-Dot (which has largely replaced the older version, Vivelle) is also available but it is brand name only so is more expensive. FemPatch is another option though not as commonly prescribed. The only estradiol patch that also has progesterone is the Combipatch, also expensive but your only combo patch option.

Dr O.

Climara runs about $95 for 4 patches without insurance, while the generic estradiol ranges from around $30 – $50 for 4 patches. Vivelle-Dot and Combipatch are slightly less at $70 – $75 for 8 patches. Estradiol patches are likely to be covered as a Tier 1 medication by most insurance plans, meaning you’ll pay your lowest co-pay; Climara is likely to be either not covered or a Tier 3 drug, falling under your highest co-pay. Vivelle-Dot and Combipatch are  likely to be considered Tier 2 by insurance companies, with a moderate co-pay.

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