Key takeaways:
Vagifem (estradiol vaginal tablets, Yuvafem) is a tablet that's inserted into the vagina to treat dryness and irritation related to menopause. It comes as a brand-name medication as well as lower-cost generic versions.
The average cost of 8 Vagifem inserts is about $207.75 without insurance. Some insurance plans cover Vagifem, but your plan may prefer the generic version or require a prior authorization.
If your insurance doesn't cover Vagifem, a free GoodRx discount and tax-advantaged healthcare accounts can help lower your out-of-pocket costs.
Save on related medications
Vagifem (estradiol vaginal tablets, Yuvafem) is a menopause hormonal therapy (MHT) medication. It’s used to treat vaginal menopause symptoms, such as dryness and irritation. Vagifem contains a lab-made form of estrogen, and you insert the tablets directly into your vagina.
The cost of Vagifem without insurance can vary based on your dosage and whether you're prescribed the brand-name or generic version. Here's what you should know about how much you can expect to pay for Vagifem without insurance along with ways to save on the cost of your prescription.
How much does Vagifem cost without insurance?
The cost of 8 brand-name Vagifem tablets (the typical monthly maintenance dose) may be over $200 without insurance. Keep in mind that the cost for your first month of treatment may be higher, since you typically insert Vagifem once daily for the first 2 weeks of treatment.
The charts below detail the average retail prices for a maintenance dose of brand-name and generic forms of Vagifem.
Vagifem Cost
Dosage | Average retail price |
|---|---|
10 mcg (8 inserts) |
Generic Vagifem Costs
Which factors affect the cost of Isentress?
Several factors can affect the cost of Vagifem, including:
Location: Where you live can affect the cost of your medication. For example, according to GoodRx research, medications are typically more affordable in Denver than in New Orleans.
Pharmacy: Cash prices can vary from one pharmacy to another, even in the same neighborhood. It’s a good idea to check a few options before filling your prescription. GoodRx can help you compare prices at pharmacies in your area.
Brand-name versus generic: In most cases, you'll pay more for brand-name Vagifem than the generic versions.
Insurance coverage: You’ll typically pay less for Vagifem if your prescription insurance covers it. But your copay may vary based on your plan’s formulary (more on that next).
Is Vagifem covered by insurance?
Almost all Medicaid plans cover Vagifem. About 21% of Affordable Care Act (ACA, also known as Obamacare) plans and 63% of all other commercial insurance plans cover this medication. Less than 10% of Medicare prescription plans cover Vagifem.
Many health insurance plans covering this medication require enrollees to get a prior authorization or do step therapy, including for more than half of people who are covered by Medicaid. A prior authorization means your prescriber may need to submit information explaining why Vagifem is medically necessary before your plan will cover it. Step therapy means you’re required to try other treatments (or explain why you aren’t able to take them) before your plan will cover Vagifem.
If your insurance covers Vagifem, the amount you’ll pay depends on where it falls within your plan’s formulary (list of covered medications). Medications are often classified into different tiers within a formulary — a lower tier typically means a lower copay. You can access your plan’s formulary and summary of benefits and coverage online or by calling the customer service number on your prescription insurance card.
How different insurance plans cover Vagifem
The table below breaks down the percentage of enrollees who have coverage for Vagifem by insurance type. It also shows the likelihood of having prior authorization and step therapy requirements.
Insurance Coverage for Vagifem 10 mcg vaginal tablets
Insurance type | Enrollees covered for this medication | Enrollees required to get a prior authorization | Enrollees required to do step therapy |
|---|---|---|---|
Commercial (not including plans purchased through an ACA marketplace) | 62.9% | 10.5% | 6.04% |
21.1% | 13.1% | 0.03% | |
Medicare, including original Medicare and Medicare Advantage plans | 7.4% | 1% | 2.15% |
Medicaid, including state-run and managed care plans | 99.4% | 56.2% | 0.92% |
Source: Managed Markets Insight & Technology, LLC™, as of December 13, 2024. (See methodology below.)
Tips if Vagifem isn’t covered by your insurance
If your insurance doesn’t cover Vagifem, here are a few options to try:
Ask for an formulary exception. If denied, file an appeal with your plan.
Look for other ways to save on the cost of your prescription, such as a GoodRx coupon (more on that next).
Ask your prescriber about switching to a different form of vaginal estrogen that's more likely to be covered by your insurance.
Consider changing your prescription medication coverage during your next open enrollment period.
Ways to save on Vagifem without insurance
Here are some ways to save on the cost of Vagifem.
1. Use a GoodRx coupon
With a GoodRx coupon, you may be able to pay a lower price for your Vagifem prescription. You may be able to get an 8-dose package of brand-name Vagifem for as low as $179.11 with a free GoodRx coupon. And with GoodRx, 8 generic estradiol vaginal tablets can cost as little as $37.83
Here’s how to get a coupon:
Visit www.goodrx.com, or install the GoodRx app on your mobile device.
Type “Vagifem” in the search field.
Choose the correct quantity, brand or generic form, and location.
Click or tap on “Search prices” to find prices at pharmacies near you.
Choose to receive your coupon via text or email, or print it out.
Provide the coupon information to pharmacy staff before you pick up your prescription. This will help prevent delays at the pickup counter.
2. Get a 3-month supply
Some insurance plans offer lower copays when you fill a 3-month supply instead of 1 month at a time. Ask your prescriber about switching to a 3-month supply of Vagifem if your plan provides this benefit. Keep in mind that they may require you to use the plan's mail-order pharmacy to access the lower price.
Many pharmacies also discount the cash price of larger prescription quantities, which can help if you’re paying out of pocket.
3. Tap into your HSA, FSA, or HRA
If you have a health savings account (HSA), a flexible spending account (FSA), or a health reimbursement arrangement (HRA), you can use it to help cover your out-of-pocket costs for Orilissa. These tax-advantaged health accounts let you pay for eligible expenses with tax-free dollars.
Pay directly with your HSA or FSA card at the pharmacy, or cover the cost yourself and submit a request for reimbursement. The funds in an HSA or an HRA typically roll over annually, but you have to use your FSA dollars before the deadline or they’ll expire.
The bottom line
Vagifem (estradiol vaginal tablets, Yuvafem) is a tablet that's inserted into the vagina to treat dryness and irritation related to menopause. The average cost of 8 brand-name Vagifem inserts (a typical maintenance dosage) is about $207.75 without insurance.
Some insurance plans cover Vagifem, but your coverage may prefer the generic version or require a prior authorization. If your insurance doesn't cover Vagifem, a free GoodRx discount and using tax-advantaged healthcare accounts can help lower your out-of-pocket costs.
Why trust our experts?
Methodology
We obtained national prescription coverage data for each medication from Managed Markets Insight & Technology (MMIT). The data reflects health insurance coverage as of December 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).
References
Medicaid.gov. (n.d.). Managed care.
