The Medical Letter on Drugs and Therapeutics
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In Brief: Femlyv – An Orally-Disintegrating Hormonal Contraceptive
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Med Lett Drugs Ther. 2024 Nov 7;66(5092):1   doi:10.58347/tml.2024.5092a
Disclosures
Objective(s)

Femlyv (Millicent), an orally-disintegrating tablet containing ethinyl estradiol and norethindrone acetate, has been approved by the FDA for prevention of pregnancy in females with a body mass index (BMI) ≤35 kg/m2. It is the first hormonal contraceptive to become available in an orally-disintegrating tablet formulation. Traditional oral and chewable tablets containing ethinyl estradiol and norethindrone acetate in a wide range of doses, including those found in Femlyv, have been available in the US for years.

CHOICE OF CONTRACEPTIVES — Intrauterine devices (IUDs) and the etonogestrel implant (Nexplanon) are the most effective reversible contraceptive methods, but they require an office visit for placement and removal. Combination and progestin-only hormonal contraceptives (oral tablets, transdermal patches, vaginal rings) and injectable medroxyprogesterone acetate are also highly effective for preventing pregnancy.1

DOSAGE AND ADMINISTRATION ― Femlyv is supplied in cartons containing 3 blister cards. Each blister card contains 24 active (0.02 mg of ethinyl estradiol and 1 mg of norethindrone acetate) and 4 inert spearmint-flavored tablets. The recommended dosage is one tablet taken once daily in the order directed on the blister card. The tablet should be placed on top of the tongue and allowed to disintegrate. Patients should drink 8 ounces of water afterwards.

COST ― The wholesale acquisition cost (WAC) for an 84-day supply of Femlyv is $591, compared to $20-260 for traditional oral or chewable contraceptive tablets containing the same hormones.2

CONCLUSION ― The orally-disintegrating hormonal combination oral contraceptive Femlyv is an acceptable option for females who have difficulty swallowing traditional tablets, but chewable oral contraceptives containing the same two hormones as Femlyv are available at a lower cost.

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