Generic Birth Control Explained
How is generic birth control different? And why do the same pills go by so many different names? Nurx Dr. Julie Graves answers all your generic birth control questions.
When prescribing birth control, the Nurx medical team usually prescribes generic formulas. Why? Because it almost always costs less for you, whether you’re paying out-of-pocket or with insurance, and because from a medical perspective brand-name birth control and generics are the exact same thing. We get a lot of questions (and occasionally complaints) from patients about generic birth control, so we asked Dr. Julie Graves, MD, MPH, PhD, Associate Director of Clinical Services at Nurx, to answer the questions we hear most.
What’s different about generic birth control?
Dr. Graves: The short answer: Nothing important. The Food and Drug Administration requires that generics contain the exact same dose of the exact same hormones as the originally patented “brand name” version of the medication. Drug manufacturers have quality controls, and are well-regulated by the FDA.
However, generics may have different inactive ingredients than the branded version and than other generic versions of the same medication—ingredients like coloring and fillers may be different, but these ingredients don’t affect the potency or how the medication does its job.
Are there any people who shouldn’t take a generic version?
Dr. Graves: In rare cases an inactive ingredient in a particular generic can cause an allergy or reaction, so if that’s true for you make sure your medical provider knows. One of the most common ingredients to cause a reaction is a yellow dye called tartrazine. Pill manufacturers use this or other colors to make the pills look pretty, or to distinguish the active pills from the placebo pills.
If you have an allergy or known reaction to anything, always tell your medical provider or pharmacist. But even if you have a reaction to a particular generic, that doesn’t usually mean you’d have to take a name-brand version. There are multiple generic versions of birth control pills, so you can likely find another generic of that same medication that doesn’t contain the dye or other ingredient you react to.
Why are there so many birth control pills that go by different names even though they’re the same thing?
Dr. Graves: A unique thing about birth control pills that causes lots of confusion is that a formula may be made by multiple manufacturers and they’ll each give their particular pill its own name. Most medication has a brand name and then a chemical name, and the generics are usually given the chemical name. One example is the herpes medication valacyclovir—the branded version is called Valtrex, and the generic versions are always called valacyclovir. But with birth control pills manufacturers give generics different names. As just one of many examples Junel and Microgestin are both generics that have the same active ingredients but different inactives and different packaging. The manufacturers are trying to get patients to be loyal to a brand, so they aren’t clear in their marketing materials that these are generics.
This can create frustration for patients because they’ll want to stick with the name and packaging they know, but their insurance might cover another generic and not the one they’re familiar with. Or if they’re paying out-of-pocket we may be able to give them a different generic with a lower price.
Are there some pills that don’t have a generic version, that might be worth the extra money?
Dr. Graves: There’s Lo Loestrin, which has the lowest estrogen does you can get in the US, and Slynd, a progestin-only pill with a type of progestin called drospirenone, and some people do do really well on these pills, so if your insurance covers them with a low copay it could be worth it to you to pay that copay depending on how affordable it is. There are also some new chewable and softgel pills that are patented.
In general though, brand name pills tend to be significantly more expensive so unless there is a real medical reason to be on one of these, which is rare, a generic option just makes sense.
What should a patient do if they think the generic pill they’re taking is causing unpleasant side effects?
Dr. Graves: Write down what you’re experiencing, perhaps by using a calendar app that allows you to record bleeding days and symptoms, then work together with your medical provider (whether at Nurx or elsewhere) so you can determine whether the inactive ingredients in your new generic pill are causing the side effects. It’s very rare that this would be the case. When a patient thinks they’re reacting to an inactive ingredient in a generic pill and need a different formulation, it’s usually a reverse placebo effect — say, a patient starts experiencing headaches and thinks it’s the pill when the headaches are actually caused by stress or poor sleep because of changes at work or in personal life. I want us to work as a team and figure out what’s causing your symptoms before switching pills, especially if the new pill is going to cost you more.
I had a patient who was having trouble with sleep, and we messaged back and forth about it and she had Covid stress and job stress. We figured out that it was the stress causing her sleep issues, and we worked out some ways for her to manage that. One of the things I love about Nurx is we have this platform that allows us to take the time to message with patients, figure out what’s going on, and find a solution together.
Dr. Julie Graves is a family medicine and public health doctor, as well as the Associate Director of Clinical Services at Nurx. She has more than 20 years of experience and has practiced medicine in Texas, Florida, Maryland, Wisconsin, Washington, DC, Sint Maarten, Germany, and even on a cruise ship. Dr. Graves also enjoys working in telehealth because it provides patients with convenience and comfort, enables them to ask questions at any time, and protects their privacy.
This blog provides information about telemedicine, health and related subjects. The blog content and any linked materials herein are not intended to be, and should not be construed as a substitute for, medical or healthcare advice, diagnosis or treatment. Any reader or person with a medical concern should consult with an appropriately-licensed physician or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.