What pills do you offer? Readers share options
A quick check of the charts shows the next patient is a 21-year-old nonsmoking women. If she is a candidate for oral contraceptives (OCs), which one will you choose? Participants in the 2007 Contraceptive Technology Update Contraception Survey say their No. 1 oral contraceptive (OC) of choice is Yasmin, a monophasic pill containing 3 mg drospirenone and 0.030 mg ethinyl estradiol from Berlex, the U.S. affiliate of Bayer HealthCare Pharmaceuticals in Wayne, NJ.
Yasmin leads the nonformulary category for the second year in a row. It is followed by Ortho Tri-Cyclen Lo (Ortho-McNeil Pharmaceutical; Raritan, NJ) and Alesse, from Wyeth Pharmaceuticals; Collegeville, PA. (See the graphic, below, on top nonformulary pills.) Ortho Tri-Cyclen Lo is a triphasic pill that contains 25 mcg of estrogen for 21 days and three doses of the progestin norgestimate (180 mcg daily/days 1-7; 215 mcg daily/days 8-14; 250 mcg daily/days 15-21). Alesse is a monophasic 20-mcg pill.
Joe Childress, MD, a physician at the Institute for Women's Health in San Antonio, likes the progestin in Yasmin. The progestin, drospirenone, is a spironolactone analogue with antimineralocorticoid properties.
When bound by formulary, about 32% of 2006 survey participants say they write prescriptions for Ortho Tri-Cyclen Lo for young nonsmoking women. Alesse and Yasmin were other leading choices in the 2007 formulary category.
More generics in use
The year 2007 saw the addition of the first combination contraceptive pill, Lybrel from Wyeth Pharmaceuticals of Collegeville, PA. The drug is designed to be taken 365 days a year, without a placebo phase or pill-free interval. Also, the Food and Drug Administration gave approval to a separate indication for the treatment of acne to Yaz, a 20 mcg ethinyl estradiol/3 mg drospirenone pill from Berlex.
However, the addition of new pills to the market may not signal the expansion of your family planning facility's formulary. Almost 65% of participants in the 2007 CTU Contraception Survey say their facilities have increased the use of generic oral contraceptives due to budget constraints. While U.S. clinicians have been able to choose from a variety of generic OCs for a number of years, Canadian clinicians have just seen approval of the first generic birth control pill in the form of Portia, a pill with 0.15 mg levonorgestrel and 0.03 mg ethinyl estradiol from Barr Laboratories of Pomona, NY.
Affordable options are a must
Affordable options are a must, says Tricia Trow Weaver, PA-C, a physician's assistant at the University of South Florida Student Health Services Women's Clinic in Tampa. When possible, Weaver writes a prescription for a branded product when the patient has insurance with an affordable copay. Students often prefer to purchase what the student center has on formulary, she notes.
While the contraceptive patch and vaginal ring have gained popularity with family planning patients, the Pill still holds a top spot, say participants in the 2007 CTU survey. Case in point: Ruth Miner, RN, CNP, a nurse practitioner at the Jackson County Health Department in Murphysboro, IL, says at least 75% of women who seek care at the facility use pills, and that number has been increasing.
About 42% of 2007 survey participants report that more than half of their patients leave the office with an OC prescription in hand. This number reflects an increase from 2006's 37% figure.