How Much Is Nexplanon Without Insurance?

If you don’t want to take a birth control pill or have an intrauterine device (IUD) inserted, Nexplanon (etonogestrel) may be an attractive alternative.

Nexplanon is an FDA-approved birth control implant. It’s administered when a healthcare professional inserts a small flexible rod under the skin of your upper arm during an outpatient office visit.

Nexplanon is more than 99% effective at preventing pregnancy for up to 3 years. After 3 years, it must be removed and replaced with a new one for continued contraception. You can also have it removed earlier than 3 years. But as soon as the Nexplanon rod is removed, you no longer have its pregnancy prevention.

Having Nexplanon inserted generally takes less than 30 minutes, but you may need multiple consultations before the procedure. The total cost of Nexplanon may include insertion, consultation, and removal fees.

Nexplanon basics

The chart below provides a summary of basic information about Nexplanon.

Nexplanon basics

Is Nexplanon covered by insurance?

Under the Affordable Care Act (ACA), health insurance plans must cover preventive care — including some methods of birth control — without charging out-of-pocket costs such as copayments or coinsurance. But they are not required to cover every brand of contraceptive. Some religious employers do not have to cover birth control.

And while many commercial, ACA, and Medicaid plans cover Nexplanon, many Medicare plans do not.

If you have insurance, check your plan’s summary of benefits and coverage and formulary to determine whether Nexplanon is covered.

How insurance covers Nexplanon

Nexplanon is covered for most people with insurance other than Medicare. Most health insurance plans covering this medication don’t require prior authorization or step therapy. But prior authorization will be required for about 1 in 7 people with Medicaid and about 1 in 11 people with commercial insurance plans not purchased through the ACA marketplace.

EXPERT PICKS: WHAT TO READ NEXT

• There’s a long-term birth control implant: Nexplanon is a tiny plastic rod implanted in the upper arm that can prevent pregnancy for up to 3 years.

• Common questions about the birth control implant: Does Nexplanon cause weight gain or infertility? Find the answers here.

• The side effects of Nexplanon: From headaches to vaginal pain, learn what  common side effects you might experience with the birth control implant.

The following chart shows your likelihood of coverage, or your chances of facing restrictions — such as prior authorization and step therapy — based on your type of insurance.

Insurance coverage for Nexplanon

Source: Managed Markets Insight & Technology, LLC™, as of October 17, 2024. (See methodology below.)

Tips if your medication isn’t covered by insurance

Here are a few options to try if your insurance does not cover Nexplanon:

• Talk to your prescriber about alternatives.

• Ask for an exception from your prescription medication plan. Keep in mind you may be required to do step therapy or get a prior authorization to be covered.

• File an appeal with your plan.

• Consider changing your prescription medication coverage during your next open enrollment period.

You can use a GoodRx coupon for savings with some medications, but there are no coupons for Nexplanon. This is because the device is inserted in a prescriber’s office and isn’t sold in a pharmacy.

How much does Nexplanon cost without insurance?

If you don’t have health insurance, what you’ll pay for Nexplanon will depend on the following factors:

• Geographic location

• The cost of the device at your healthcare professional’s office

• The cost of visits with your healthcare professional, which could include consultations, insertion and removal fees, and follow-up appointments

• Whether you qualify for an assistance program

Without insurance, the list price for 1 Nexplanon implant providing up to 3 years of pregnancy prevention was around $1,100 at the time of publication. That doesn’t include potential costs to implant or remove the device, which could range from from $0 to $300. That may seem like a high price, but the annual cost of birth control could be as much as $2,400.

You may be charged more for Nexplanon depending on where you live or the facility you visit for your device to be inserted. For example, your costs may be lower if you receive the implant at a safety net clinic such as Planned Parenthood, because these sites participate in the federal Title X Family Planning Program, which helps them provide low-cost or free contraceptives.

How to afford Nexplanon without insurance

If your insurance doesn’t cover Nexplanon, there are still ways to save money. Try these tips.

1. Compare prices with various healthcare professionals

You may be able to have your implant inserted by a physician, a nurse, or another healthcare professional. The cost of the device and the price of your visit may vary depending on who provides the procedure and where.

2. Ask your prescriber about alternatives

If you are concerned about the cost of Nexplanon, talk to your prescriber. There may be another form of birth control that better fits your budget.

3. Use tax-advantaged healthcare funds

If you have a health savings account (HSA), or a flexible spending account (FSA) or a health reimbursement arrangement (HRA), using those funds to buy your medication can reduce your out-of-pocket costs through tax savings.

4. Check with local healthcare organizations

If you have a financial need, you may be able to get assistance from a nonprofit organization such as Planned Parenthood that caters to women’s health and helps people find birth control methods that fit their budget.

5. See if you qualify for a patient assistance program

Organon, the company that manufactures Nexplanon, does not offer a patient assistance program for the device. But there may be other organizations that do.

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Written by:

Tamara E. Holmes

Tamara E. Holmes is a Washington, DC-based freelance journalist and content strategist who has been writing about personal finance, health, and health insurance for more than a decade. Her work has appeared in various print and online publications, such as USA Today, AARP, Working Mother, and Diversity Woman.

Edited by:

Cindy George, MPH

Cindy George is the senior personal finance editor at GoodRx. She is an endlessly curious health journalist and digital storyteller.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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Methodology

We obtained national prescription coverage data for each medication from Managed Markets Insight & Technology (MMIT). The data reflect health insurance coverage as of October 2024.

We calculated the percentage of enrollees in plans that cover each medication by dividing the number of enrollees covered for the medication within a specific insurance channel (e.g., ACA, Medicare, Medicaid) by the total number of enrollees in all plans within that channel. 

We determined the percentage of enrollees in plans with a prior authorization requirement by calculating the proportion of enrollees in plans that required prior authorization for the medication within each channel.

Finally, we measured the percentage of enrollees in plans with a step therapy requirement by calculating the proportion of enrollees in plans that imposed step therapy requirements for the medication in each channel.

These estimates, derived from national MMIT coverage data, provide insight into health insurance coverage for each medication. They take into account restrictions such as prior authorization, step therapy, and quantity limits. The percentages are expressed relative to the total number of enrollees covered by various insurance channels, including the ACA, commercial (excluding ACA) plans, Medicare, and Medicaid (both state-run and managed care plans).