Why is Estring so expensive?

Medically reviewed by Dr. Jamie Winn
Aug 17, 2023

Estring is an FDA-approved vaginal ring that reduces menopausal symptoms like vaginal dryness and painful sex. With no generic available, it is an expensive form of hormone replacement therapy, especially if you do not have insurance coverage. Americans can expect to pay close to $600 for one Estring 2 mg vaginal ring from a US pharmacy. Because one ring lasts 90 days, that averages to almost $200 a month. Through our network of Canadian, UK, and other international pharmacies, you can get the same medication for only $135 through Universal Drug Store (UDS). This equals about $44 a month or over 70% off the retail price. You can save up to 80% on thousands of other meds by ordering from UDS. Many of the medications at UDS are at a lower price than you will find with discount cards such as GoodRx.

Keep reading as we discuss how Estring helps postmenopausal women, why it is so expensive, and what options you have to save money on your prescription.

What affects the price of Estring?

Several factors can add to the cost of medications in the United States. Some of these include research and development (R&D), clinical trials, manufacturing, and marketing, as well as insurance coverage and pricing. Government regulations can also play a role in medication pricing, with some countries negotiating drug prices on behalf of their citizens, resulting in lower costs.

Estring FAQs

What is Estring prescribed for?

Estring is a brand-name prescription medication that is manufactured by the pharmaceutical company Pfizer. The active ingredient, estradiol, is a synthetic form of estrogen that is used to treat a condition called atrophic vaginitis. Also called vaginal atrophy, atrophic vaginitis can cause symptoms such as vaginal burning, dryness, painful sex (due to decreased natural lubrication), and painful urination. This condition commonly happens in women going through menopause.

Menopause typically begins in women between 45 and 55 years years of age. When menopause occurs, the production of estrogen and progesterone decreases. It is the low estrogen levels that cause most of the symptoms of menopause. These symptoms include fewer periods, hot flashes, night sweats, insomnia, mood changes, vaginal changes, urinary tract infections, sexual dysfunction, and weaker bones.

Estring is a vaginal estrogen that helps get your estrogen back to normal levels, which helps relieve your menopausal symptoms. Unlike topical estrogen creams that have to be applied daily or multiple times a week, Estring is a soft, flexible ring that lasts 3 months. Once inserted, it slowly releases a low dose of estrogen all on its own so you don’t have to worry about measuring doses or messy applicators.

What are the side effects of Estring?

Estrogen therapy is not intended to be long-term. It should be used at the lowest dose possible, only for as long as needed. This helps minimize the risk of side effects. Some common side effects of Estring include:

Headache
Vaginal discharge
Vaginal yeast infection
Back pain
Vaginal pain, irritation, inflammation, or discomfort
Vaginal bleeding
Upper respiratory tract infection
Vaginal bacterial infection

Estring sometimes causes more serious side effects such as:

Allergic reactions
Increased risk of blood clots, heart attack, or stroke
Dementia
Increased risk of uterine, ovarian, and breast cancer
High blood pressure
High blood sugar
Gallbladder problems
Liver problems
Increased or decreased thyroid hormone levels
Enlargement of benign tumors of the uterus (fibroids)

These are not all of the possible side effects of Estring. You should always seek medical advice from your healthcare professional for any questions or concerns about your medical condition or treatment. You can also report adverse effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.

Is there a generic version of Estring?

Currently, there is no generic available for Estring in the United States.

When will Estring become generic?

Estring was approved by the FDA in 1996, so its patent has been in place for over 25 years. Currently, there is no generic for Estring, and it is not known when one will be available.

How much does Estring cost in the U.S.?

Your out-of-pocket cost for Estring will vary depending on your insurance plan as well as the pharmacy you use. If you don’t have insurance or if your prescription drug plan does not cover it, Estring can be expensive. The average cost of a 90-day supply (1 ring) of Estring 2 mg ring is almost $600. If your insurance company does not pay for Estring, talk with your healthcare provider to see if there is an alternative medication this covered that might be right for you.

Is Estring covered by insurance?

Every insurance plan has a different formulary of medications they cover so you will have to contact your individual plan to see if Estring is covered. However, it is estimated that about 45% of Medicare drug plans cover this medication.

How can you save money on Estring?

The estimated yearly retail cost of Estring without insurance is around $2,400. Even with insurance, you may not be able to afford the copay of Estring. There are several ways you can save money on Estring, including:

Order from Universal Drugstore (UDS)

You don’t need an Estring coupon or discount card to save up to 80% on this medication if you purchase it from UDS. We are the global leader in online prescription drug savings with almost 20 years of experience supplying prescription and over-the-counter (OTC) medications to our customers. Check out our online pharmacy to find the lowest drug price on Estring and many other medications.

Copay or savings card

For certain patients on Estring, there is a savings card offered by Pfizer that will help you save money on your prescription. Eligible patients can pay as little as $45 on each of their next 4 Estring prescriptions by using this savings card. It is limited to $100 per use or the amount of your co-pay, whichever is less, up to a maximum annual savings of $400.

You can not use this card if your insurance plan covers the entire cost of your prescription. You are also not eligible if you have federal or state-issued insurance such as Medicare, Medicare Part D, Medicaid, or Tricare. Check out the Estring savings and support page for more details.

Medicaid

You may be eligible for Medicaid, depending on your yearly income. Medicaid is used to help low-income individuals and may cover the cost of Estring. Check with your local Medicaid office or website to see if you qualify.

Discount cards

You may be able to save money by using a prescription discount card. These cards can be used at your local pharmacy, even if you have insurance.

Compare prices

Check the price of Estring at multiple pharmacies to find the cheapest option. This should include online and mail-order pharmacies. The retail prices for the same prescription medicine can vary by hundreds of dollars at different pharmacies, even in the same city.

Find an alternative medication

Ask your healthcare provider for medical advice about an alternative medication you can use to treat your menopausal symptoms. Some alternatives to Estring include Premarin Vaginal Cream, Vagifem Vaginal Tablets, Estrace Vaginal Cream, Nuvaring, and Estrace Tablets. Try contacting your insurance company to see if they cover any of these other medications, and then ask your healthcare provider which one might be right for you.

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