What OCs do clinicians prescribe most often?
The next chart in your inbox is for a healthy 21-year-old nonsmoking woman. She indicates she is interested in using an oral contraceptive (OC) for birth control. What pill do you prescribe?
Ortho Tri-Cyclen Lo (Ortho-McNeil Pharmaceutical; Raritan, NJ) continues as the top pick for young women when no formulary issues dictate pill selections, a spot it has held since 2008. (See graphic below.)
Ortho Tri-Cyclen was named as top pill for this age category when clinicians are bound by available pills in their formulary, changing positions from last year's number two spot. Ortho Tri-Cyclen Lo was the top formulary pill in the 2009 poll.
Ortho Tri-Cyclen Lo is a triphasic pill which contains 25 mcg of ethinyl estradiol 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). Ortho Tri-Cyclen also is a triphasic pill using the same progestin levels, but with 35 mcg of ethinyl estradiol.
Alesse, a monophasic 20 mcg pill from Wyeth Pharmaceuticals of Collegeville, PA, remains in its top spot as the pill of choice for older women, named by 42% of 2010 survey respondents. (See graphic below.) It is followed by 2009's leader, Loestrin, another 20 mcg pill from Teva Pharmaceuticals USA, North Wales, PA. A total of 17% of respondents named it as first choice for a 42-year-old nonsmoking woman.
Alesse also continues as the leading option for women who have experienced nausea when using previous pills. The pill has been named the top choice in this category since 1999. Ortho Tri-Cyclen Lo was named as the second-choice pill.
Check generic OC use
More than half of survey respondents say their use of generic OC formulations has increased due to budget constraints. About 62% of 2010 respondents say they have increased use of generic brands, as did 68% in 2009.
Clinicians at Planned Parenthood of Illinois in Chicago consistently have been using generic oral contraceptives, says Kai Tao, ND, MPH, CNM, vice president of clinical operations and associate medical director. "We do lots of education to our patients that 'a pill is a pill, is a pill'," says Tao.
Using generic pills has not impacted practice for Marnie Schumacher, ARNP, a nurse practitioner at Grays Harbor County Public Health Department in Aberdeen, WA. "Our clients are very accepting of generic brands, and if they prefer the brand name, I can always write a prescription with a 'do not substitute,'" says Schumacher.
Patients are pleased to find that generic pills are available when they are beginning use of oral contraceptives, says Susan Krasner, CNM, MS, APRN, a certified nurse midwife at Dartmouth-Hitchcock Nashua Obstetrics and Gynecology in Nashua, NH. "We also have many patients who take advantage of Wal-Mart discounted pharmacy products," says Krasner. "Many patients will call the office to be changed to a generic formula if copayment is too high on brand name OCs."
Insurance formularies can influence what pill is prescribed, says Donna Price, ARNP, a nurse practitioner at Duval County Health Department in Jacksonville, FL. "I find that I am ordering pills to meet the requirements of the insurance that they are on rather than the pill I would like to order," says Price.
Can smokers use OCs?
If a healthy patient who is 23 years old and smokes 10 cigarettes a day says she would like to use the Pill, would you write a prescription? Almost 100% of 2010 survey respondents said they would. Ninety-nine percent checked "yes" for prescribing pills to women ages 20-24 who smoke 10 cigarettes per day.
The U.S. Medical Eligibility Criteria for Contraceptive Use rates use of combined hormonal contraceptives for smokers under age 35 as a 2 a condition for which the advantages of using the method generally outweigh the theoretical or proven risks.1
However, when it comes to a 40-year-old woman who smokes 10 cigarettes a day, clinicians are just as emphatic in not providing pills. A total of 96% of 2010 survey respondents said they would not write a pill prescription for such women. The U.S. eligibility guidelines rank combined hormonal contraceptive use for women age 35 or older who smoke less than 15 cigarettes per day as a 3 a condition for which the theoretical or proven risks usually outweigh the advantages of using the method. For women in the same age range who smoke 15 cigarettes or more per day, the guidelines rank combined hormonal contraceptive use as a 4 where the condition represents an unacceptable health risk if the method is used.1
- Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use. MMWR 2010;59(RR04):1-6.