weeks (21 total days) on the same day each week No TDS is worn during Week 4 If a TDS is applied after the first 24 hr of menstruation, use nonhormonal back-up contraception (eg, condoms and spermicide, diaphragm and spermicide) concurrently for first 7 days of first cycle only Switching from an oral combination hormonal contraceptive Complete the current pill cycle and apply the first TDS on the day the next pill cycle would normally start If menses does not occur within a week after taking the last active pill, instruct the woman to consult with a healthcare professional to be sure that pregnancy has not occurred If no pregnancy has occurred, TDS may be started for contraception If initiated >1 week after taking the last active pill, use nonhormonal back-up contraception (eg, condoms and spermicide, diaphragm and spermicide) concurrently for first 7 days Switching from a transdermal hormonal contraceptive Complete current TDS cycle and apply the first Twirla TDS on the day the next TDS cycle would normally start If menses does not occur within a week after removing the last TDS, consult with a healthcare professional to ensure pregnancy has not occurred If no pregnancy has occurred, Twirla TDS may be started for contraception If Twirla TDS is applied >1 week after removal of the last TDS, use nonhormonal back-up contraception (eg, condoms and spermicide, diaphragm and spermicide) concurrently for first 7 days Switching from vaginal ring Complete vaginal ring cycle and apply the first TDS on the day the next vaginal ring would normally start If menses does not occur within a week after removing vaginal ring, consult with a healthcare professional to ensure pregnancy has not occurred If no pregnancy has occurred, TDS may be started for contraception If TDS is applied >1 week after vaginal ring removal, use nonhormonal back-up contraception (eg, condoms and spermicide, or diaphragm and spermicide) concurrently for first 7 days Injection, intrauterine system, implant, or progestin-only pill Injection: Apply first TDS on the day the next injection would normally occur Intrauterine system or implant: Apply first TDS on the day of intrauterine system/implant removal Progestin-only pill: Apply first TDS on the day the next progestin-only pill cycle would normally start Starting after abortion or miscarriage First trimester abortion or miscarriage May be started immediately within the first 5 days following a complete first trimester abortion or miscarriage without additional back-up contraception If >5 days have elapsed from the first trimester abortion or miscarriage, use nonhormonal contraception (eg, condoms and spermicide, diaphragm and spermicide) and follow instructions for starting TDS for the first time Ovulation may occur within 10 days of an abortion or miscarriage Second trimester abortion or miscarriage Do not start earlier than 4 weeks after a second trimester abortion or miscarriage owing to increased risk of thromboembolism Starting after childbirth For women who elect not to breastfeed, do not start sooner than 4 weeks after childbirth owing to increased risk of thromboembolism If a woman begins using TDS postpartum and has not yet had a period, consider possibility of ovulation and pregnancy; obtain pregnancy test to guide action If not pregnant, use nonhormonal back-up contraception (eg, condoms and spermicide, diaphragm and spermicide) for the first 7 days of TDS use Missed doses Forgetting to change TDS At the start of any TDS cycle (Week 1/Day 1): May not be protected from pregnancy; apply the first TDS as soon as possible (this now starts a new 4-week cycle and is now the new Patch Change Day); use nonhormonal back-up contraception for 7 days In the middle of TDS cycle (Week 2/Day 8 or Week 3/Day 15), for up to 48 hr: Apply new TDS immediately; apply next TDS on the usual Patch Change Day; no back-up contraception needed ≥48 hr: May not be protected from pregnancy; stop current TDS cycle and start a new 4-week cycle immediately by applying a new TDS (this is now a new Patch Change Day); use nonhormonal back-up contraception for 7 days At end of TDS cycle Week 3 (Day 22): If the woman forgets to remove her TDS, she should take it off as soon as she remembers; start next cycle on the usual Patch Change Day, which is the day after Day 28; no back-up contraception needed Storage Store in original pouch until application time Store at room temperature 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF) No images available for this drug. No images available for this drug.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions Tier Description 1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs. 2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs. 3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs. 4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. NC NOT COVERED – Drugs that are not covered by the plan. Code Definition PA Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription. QL Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. ST Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription. OR Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription. 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