regimen No hormonal contraceptive use in preceding cycle Insert ring on the first day of menstrual bleeding May also be started on Days 2-5 of the woman’s cycle, but in this case a barrier method (eg, male condoms with spermicide) should be used for the first 7 days of the ring’s use in the first cycle Changing from other combination hormonal contraceptive (CHC) May switch from previous CHC on any day, but at the latest on the day following the usual hormone-free interval Ensure that the previous hormonal method was used consistently and correctly, and it is reasonably certain the woman is not pregnant Changing from progestin-only contraceptive Progestin-only contraceptives vary (eg, oral, implant, long-acting injection, intrauterine system) Progestin-only pill (POP): May switch on any day; instruct to insert the ring on the day after she took her last POP Intrauterine system (IUS): Switch from an implant or the IUS on the day of its removal Injection: Switch from injection when the next injection would be due In all of these cases, the woman should use an additional barrier method (eg, male condom with spermicide) for the first 7 days Use after abortion or miscarriage Complete first trimester abortion or miscarriage May start using the ring within the first 5 days; no need to use an additional method of contraception If not started within 5 days, follow the instructions for “no hormonal contraceptive use in the preceding cycle” In the meantime, use a nonhormonal contraceptive method Second trimester abortion or miscarriage Do not start earlier than 4 weeks after a second trimester abortion or miscarriage, due to the increased risk of thromboembolism Following childbirth Initiated use of ring no sooner than 4 weeks postpartum in women who elect not to breastfeed, due to the increased risk of thromboembolism in the postpartum period Also instruct her to use an additional method of contraception (eg, male condoms with spermicide) for the first 7 days Advise women who are breastfeeding not to use NuvaRing but to use other forms of contraception until the child is weaned Inadvertent removal or expulsion If the ring is accidentally expelled and is left outside of the vagina for <3 hr, contraceptive efficacy is not reduced Rinse ring with cool to lukewarm (not hot) water and reinserted as soon as possible, but at the latest within 3 hr If the ring is lost, a new vaginal ring should be inserted and the regimen should be continued without alteration If ring out of vagina >3 hr During weeks 1 and 2: Contraceptive efficacy may be reduced; reinsert the ring as soon as possible and use a barrier method (eg, condoms with spermicides) until the ring has been used continuously for 7 days During week 3: Discard that ring, and either insert a new ring immediately to start the next 3-week use period, OR insert a new ring no later than 7 days from the time the previous ring was expelled/removed and use barrier method for 7 days Prolonged ring-free interval If the ring-free interval has been extended beyond 1 week, consider the possibility of pregnancy, and an additional method of contraception (eg, male condoms with spermicide) MUST be used until the ring has been used continuously for 7 days Prolonged use or ring Left in place for up to 1 extra week (ie, up to 4 weeks total): The woman will remain protected; remove ring and insert a new ring after a 1-week ring-free interval Left in place for >4 weeks: Instruct the woman to remove the ring, and rule out pregnancy; if pregnancy is ruled out, the ring may be restarted, and an additional method of contraception MUST be used until the new ring has been used continuously for 7 days Ring breakage There have been reported cases of the disconnecting at the weld joint; this is not expected to affect the contraceptive effectiveness Vaginal discomfort or expulsion (slipping out) is more likely to occur Discard the ring and replace it with a new ring Missed menstrual period If the woman has not adhered to the prescribed regimen consider the possibility of pregnancy at the time of the first missed period and discontinue the ring if pregnancy is confirmed If the woman has adhered to the prescribed regimen and misses 2 consecutive periods, rule out pregnancy If the woman has retained 1 ring for >4 weeks, rule out pregnancy Use with other vaginal products The ring may interfere with the correct placement and position of a diaphragm; a diaphragm is therefore not recommended as a back-up contraceptive method Pharmacokinetic data show that the use of tampons has no effect on the systemic absorption of the hormones released by the ring 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. 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