Oral Micronized Progesterone Cost in New York (2026)

Oral micronized progesterone is a prescription capsule form of bioidentical progesterone, suspended in peanut oil. The brand name is Prometrium; multiple generic manufacturers (including Teva, Viatris, and Sun Pharma at various times) also produce it. It is FDA-approved for one specific use: preventing endometrial hyperplasia in postmenopausal women with an intact uterus who are also taking estrogen therapy. It is distinct from progesterone vaginal inserts, progesterone injections, and over-the-counter progesterone creams, which have different approved uses and are not interchangeable with the oral capsule for endometrial protection.

The direct answer: in New York, as elsewhere, the cost of oral micronized progesterone depends almost entirely on which of three supply channels a patient uses, brand-name Prometrium, generic oral micronized progesterone, or a compounded 503A preparation, and on insurance status. Generic pricing is consistently the lowest FDA-regulated option and brand pricing is consistently the highest, with compounded product priced separately and not covered by most insurance, including Medicaid. Exact current dollar figures for New York pharmacies, insurer copay tiers, and Medicaid prior-authorization timelines change over time and by plan, so they should be confirmed at the point of fill rather than treated as fixed facts from this page.

The question that actually matters here

The useful question for a New York patient is not "what does progesterone cost" as a single number. It is: which channel (brand, generic, or compounded) matches your insurance coverage and clinical situation, and which of the claims below are stable facts you can rely on versus numbers that must be re-verified at your pharmacy or with your plan before you budget around them. The price spread between the cheapest and most expensive channel is large enough that the channel decision matters more than shopping within a channel.

What is established about pricing structure

FDA-approved generic oral micronized progesterone has been available since the late 1990s, following FDA approval of the brand product. Generic manufacturers must demonstrate bioequivalence to the reference brand product, meaning their plasma progesterone levels fall within the FDA's standard bioequivalence range for the reference drug. This is a stable regulatory fact, not specific to New York.

Three channels exist everywhere in the U.S., including New York:

• Brand-name Prometrium, sold at the manufacturer's list price, which is typically the most expensive option unless a manufacturer savings program applies and the patient qualifies.
• Generic oral micronized progesterone, sold at retail cash price or through insurance, typically far cheaper than brand.
• Compounded oral micronized progesterone, made by a licensed 503A pharmacy under a patient-specific prescription, typically not covered by insurance and priced outside standard pharmacy benefit structures.

The FDA label for oral micronized progesterone (Prometrium) states its approved indication as prevention of endometrial hyperplasia in non-hysterectomized postmenopausal women receiving estrogen therapy (per the FDA-approved prescribing information for Prometrium). This indication, not a broader marketing claim, is what most insurance medical policies are built around.

What is plausible but needs verification for New York specifically

The following are commonly cited in pricing writeups but are date-sensitive, plan-specific, or pharmacy-specific, and none of them are confirmed by a primary source in this draft. Treat any specific dollar figure, turnaround time, or denial rate you see elsewhere the same way: as a claim to verify, not a fact to plan around.

• Exact cash prices at New York retail pharmacies (chain or independent) for generic 100 mg or 200 mg capsules.
• The current brand Prometrium list price and whether a manufacturer savings card is active, and its exact discount amount and eligibility rules.
• Compounded progesterone pricing at any specific 503A pharmacy in New York.
• New York Medicaid's specific prior-authorization turnaround time and denial-reason statistics for this drug.
• Formulary tier placement and copay amounts at specific commercial insurers (UnitedHealthcare, Aetna, Empire Blue Cross, Cigna, Oscar Health) or managed Medicaid plans (Fidelis Care, Healthfirst, MetroPlus, Molina, Amerigroup) operating in New York, since formularies change annually and sometimes mid-year.
• Discount card pricing (GoodRx, RxSaver) at specific New York pharmacies, since these prices are pharmacy- and date-specific and change frequently.

None of these figures are fabricated in this draft, and none are asserted as current facts. A patient or clinician who needs an actual number should call the dispensing pharmacy or the plan's member services line and confirm it the same day.

What clinical evidence supports about the drug itself, separate from cost

Guideline bodies, not this page, are the right source for whether progesterone co-administration is recommended alongside estrogen therapy in women with a uterus. The North American Menopause Society and the Endocrine Society have both published positions recommending progestogen therapy for endometrial protection in women with an intact uterus who use systemic estrogen. The specific journal citations for these statements should be verified directly against the North American Menopause Society and Endocrine Society websites, since the identifiers attached to this claim in earlier drafts of this page could not be confirmed against the primary literature during this revision and are not repeated here.

Older trial evidence, including NIH-sponsored research from the 1990s (commonly referenced as the PEPI trial), is often cited as showing that oral micronized progesterone protects the endometrium as effectively as synthetic progestins, with a different metabolic profile. This is a widely repeated claim in menopause literature, but the exact citation needs direct verification before it is used to support a specific numeric claim (such as an exact risk reduction) on a patient-facing page.

Observational cohort data, separately from randomized trials, has been used to argue that oral micronized progesterone combined with estrogen may carry a different breast cancer risk profile than synthetic progestin combinations. This is observational evidence, not a randomized trial result, and it should be described to patients as such: suggestive of a difference, not proof of one, and specific relative-risk numbers should not be quoted without confirming the source study.

Medicaid and commercial insurance in New York

New York Medicaid, like most state Medicaid programs, generally covers FDA-approved indications for drugs on its preferred drug list, often with prior authorization for hormone therapies. Whether oral micronized progesterone currently requires prior authorization under New York Medicaid, and what the current documentation requirements and turnaround time are, should be confirmed directly through the New York Medicaid preferred drug list or eMedNY provider resources rather than assumed from this page, since PDL rules change.

Commercial insurers licensed in New York generally place generic drugs with long-standing FDA approval, like generic oral micronized progesterone, on lower formulary tiers than newer or brand-only products. Brand Prometrium commonly requires trying the generic first (step therapy) on many commercial formularies, which is a standard cost-control practice for any drug with an available generic, not specific to progesterone. Exact tier placement and copay amounts vary by plan and by year and should be confirmed through the specific plan's current formulary document.

Compounded progesterone: what is and is not established

Compounding oral micronized progesterone at a licensed 503A pharmacy is legal in New York when done under a valid, patient-specific prescription, subject to New York State Board of Pharmacy oversight and USP nonsterile compounding standards. Common clinical reasons a prescriber might choose compounding over the commercial product include a documented peanut oil allergy (the commercial capsule uses peanut oil as its suspension medium), a need for a non-standard dose, or a need for a formulation without a specific inactive ingredient.

What is not established: compounded progesterone is not FDA-approved and is not required to demonstrate bioequivalence to the commercial product. Potency, dissolution, and absorption can vary between compounding pharmacies and even between batches at the same pharmacy, because compounded drugs do not go through the same manufacturing quality and bioequivalence testing as FDA-approved generics. Most insurance plans, including Medicaid, do not reimburse for compounded hormone preparations. Patients considering compounded progesterone should ask their prescriber why the commercial product does not meet their needs, since compounding is intended as an alternative for patients who cannot use the approved product, not a routine cost-saving substitute for it.

Telehealth prescribing

New York permits telehealth prescribing of oral micronized progesterone by New York-licensed physicians, nurse practitioners, and physician assistants, following an appropriate clinical evaluation. The current statutory basis and any restrictions on audio-only versus audio-video visits should be confirmed against current New York Department of Health telehealth guidance, since telehealth rules adopted during and after the COVID-19 public health emergency have been revised more than once and a stale citation to an older law is a common source of error on pages like this one.

Off-label uses of oral micronized progesterone, including for sleep or luteal-phase support, are prescribed by some clinicians via telehealth. Off-label prescribing is a matter of clinical judgment and is not covered by the same FDA labeling evidence as the endometrial-protection indication; insurance coverage for off-label use is inconsistent and should not be assumed.

When to escalate to in-person or urgent care

Progesterone therapy questions are rarely urgent, but unscheduled vaginal bleeding while on combined estrogen-progesterone therapy, signs of an allergic reaction (including to peanut oil in the commercial capsule), or new symptoms such as severe abdominal pain, leg swelling, chest pain, or shortness of breath warrant prompt in-person evaluation rather than a telehealth message, since these can indicate complications that need direct examination or imaging.

Verification checklist: stable facts versus facts that expire

Use this to separate what a reader can treat as durable versus what must be re-checked before making a decision, especially before budgeting or comparing plans.

Stable, federal or clinical facts (verify once, rarely change):

• Oral micronized progesterone (Prometrium and generics) is FDA-approved for endometrial hyperplasia prevention in postmenopausal women with a uterus who are on estrogen therapy, confirm against the current FDA label.
• Generic versions must meet FDA bioequivalence standards.
• Compounded progesterone is not FDA-approved and does not undergo the same bioequivalence testing.
• Guideline bodies (NAMS, Endocrine Society) recommend progestogen co-administration with estrogen in women with an intact uterus, confirm the current position statement directly on the society's site.
• The commercial capsule is suspended in peanut oil, relevant for patients with peanut allergy.

Date-sensitive, plan- or pharmacy-specific facts (re-check before relying on them):

• Cash price of generic and brand product at a specific New York pharmacy today.
• Whether a manufacturer savings card for Prometrium is currently active, and its terms.
• Whether New York Medicaid or a specific managed Medicaid plan currently requires prior authorization, and the documented turnaround time.
• Formulary tier and copay for a specific commercial insurer's current-year plan.
• Compounding pharmacy licensure status and current pricing, verified through the New York Office of the Professions license lookup.
• Current New York telehealth prescribing rules, since these have changed since the COVID-19 emergency period.

If a number cannot be confirmed through one of these current, plan- or pharmacy-specific sources, treat it as an estimate rather than a fact when making a cost decision.

What this page cannot tell you

This page cannot tell an individual patient what their own copay, prior-authorization outcome, or local pharmacy price will be, because those depend on their specific plan, pharmacy, and Medicaid managed-care organization on the date of fill. A prescriber or pharmacist, not a general reference page, is the right source for an individualized cost estimate, and neither this page nor any general source should be used to select a dose or make a treatment decision without a clinician's input.

References

Note for editorial and medical review: the source draft cited six additional PubMed identifiers (PEPI trial, NAMS position statement, Endocrine Society guideline, a Pinkerton commentary, a generic-vs-brand systematic review, and the E3N cohort study) that could not be verified against the primary literature during this revision and have been removed rather than carried forward with an unverified locator. If these claims are needed on the page, please source and re-attach the correct citations before publication. All specific New York dollar amounts, Medicaid turnaround times, denial rates, and savings-card terms from the source draft have been removed or reframed as facts requiring verification, since no source in this draft supports them at the precision originally stated.