Prometrium Cost in Wisconsin 2026: Cash Prices, Insurance, Medicaid, and Compounded Options

What Does Prometrium Actually Cost in Wisconsin in 2026?

The cash price for Prometrium in Wisconsin depends heavily on whether you use the brand, a generic, or a compounded formulation. At the AbbVie/Solvay wholesale list price, a 30-day supply of brand-name Prometrium 200 mg capsules runs $180. Most Wisconsin patients never pay that figure. Retail pharmacies using GoodRx, RxSaver, or the manufacturer savings card typically bring the cost to around $45 per month for brand or authorized generic.

Brand vs. Generic Pricing

Generic micronized progesterone capsules (100 mg and 200 mg) entered broad distribution after Prometrium's exclusivity period ended. In Wisconsin, independent pharmacies and large chains including Walgreens, CVS, and Pick 'n Save/Kroger dispense the generic at prices ranging from $30 to $55 per month for a 30-count supply, depending on the dose. The FDA maintains a current list of approved micronized progesterone generics in its Orange Book, which you can search at accessdata.fda.gov.

The brand-name Prometrium label was approved by FDA and the full prescribing information, including bioequivalence data for the peanut-oil-based capsule formulation, is archived at the FDA Drugs@FDA database. Patients with peanut allergies should confirm formulation details with their dispensing pharmacist, because the brand capsule uses peanut oil as an excipient; some generics may differ.

Compounded Micronized Progesterone Pricing

Licensed 503A compounding pharmacies in Wisconsin may prepare micronized progesterone capsules for individual patients under a valid prescription. The average cost is approximately $25 per month, making it the lowest-cost option available. The trade-off is that compounded preparations lack the FDA bioequivalence testing required of approved generics. The Endocrine Society's 2015 clinical practice guideline on menopausal hormone therapy notes that clinicians should use FDA-approved products when available and reserve compounding for documented clinical needs such as allergy to an excipient or a dose that cannot be achieved with a commercial product [1].

Price Comparison Table

| Formulation | Typical Wisconsin Cost (2026) | FDA-Approved? | |---|---|---| | Brand Prometrium 200 mg (30 caps) | ~$180 list / ~$45 with coupon | Yes | | Generic micronized progesterone 200 mg (30 caps) | $30, $55 cash | Yes | | Compounded micronized progesterone 200 mg (30 caps) | ~$25 | No (503A) |

Does Wisconsin Medicaid Cover Prometrium?

Wisconsin Medicaid (ForwardHealth) covers Prometrium and its generic equivalents, but coverage requires prior authorization (PA) for most uses. The PA process typically requires the prescriber to document the indication, confirm the patient has an intact uterus (for endometrial-protection indications with estrogen therapy), and attest that an FDA-approved option is being used. Wisconsin ForwardHealth program information is available through the state's official portal at Wisconsin DHS ForwardHealth, though formulary decisions should be verified directly with a pharmacy or prescriber at the time of prescribing.

What Prior Authorization Requires

For endometrial protection in postmenopausal hormone replacement therapy, the PA submission generally must include:

• Confirmed indication (e.g., protection of endometrium in a patient using systemic estrogen)
• Documentation that the patient has a uterus
• The prescriber's NPI and DEA information
• Confirmation that an FDA-approved product is being requested

PA approvals for Prometrium or generic micronized progesterone under ForwardHealth are typically valid for 12 months and renewable. The National Library of Medicine's DailyMed database provides the current Prometrium label, which prescribers may reference when preparing PA documentation [2].

ForwardHealth Preferred Drug List Considerations

Wisconsin ForwardHealth maintains a Preferred Drug List (PDL). Generic micronized progesterone capsules are generally preferred over brand-name Prometrium on cost grounds. If the prescriber writes "brand medically necessary," the PA documentation must justify why the generic is clinically inadequate. For most patients, the generic is therapeutically equivalent and preferred under Medicaid rules.

The American College of Obstetricians and Gynecologists (ACOG) notes in Practice Bulletin No. 141 that "progestogen use is mandatory in women with a uterus who are taking systemic estrogen to prevent endometrial hyperplasia" [3]. That clinical mandate is central to any PA justification for progesterone in HRT.

Which Wisconsin Insurance Plans Cover Prometrium?

Most commercial insurance plans operating in Wisconsin, including plans sold on the ACA marketplace and employer-sponsored plans, list generic micronized progesterone on Tier 1 or Tier 2 of their formulary. Brand Prometrium often sits on Tier 3, generating a higher copay.

Tier Placement by Plan Type

Employer-sponsored plans (large group): Generic micronized progesterone is typically Tier 1 (preferred generic), with copays of $5, $15 per 30-day fill. Brand Prometrium may be Tier 3 at $45, $75 per fill before deductible.

ACA marketplace plans (Silver and Gold): Wisconsin marketplace plans from major carriers including Quartz, MercyCare, and Dean Health generally place generic micronized progesterone on Tier 2 at $20, $40 copay after deductible. The Affordable Care Act's preventive services mandate, as interpreted for women's health, has led some plans to cover progesterone at $0 when prescribed for certain preventive indications, but this varies by plan and is not universal.

Medicare Part D: Prometrium and generic micronized progesterone are covered under most Wisconsin Part D plans in 2026. Coverage falls under the formulary tier system set by each Prescription Drug Plan (PDP). The Centers for Medicare and Medicaid Services (CMS) publishes Part D formulary files at cms.gov, and Wisconsin beneficiaries can use the Medicare Plan Finder to verify coverage before enrolling.

How to Verify Your Plan's Formulary

Call the member services number on your insurance card and ask specifically: "Is generic micronized progesterone 200 mg capsule on the formulary, and what tier?" Formulary databases can be months out of date online. A direct call generates a time-stamped verbal confirmation you can reference in a coverage dispute.

Is Compounded Micronized Progesterone Legal in Wisconsin?

Compounded micronized progesterone is legal in Wisconsin when prepared by a state-licensed 503A pharmacy operating under a valid patient-specific prescription from a licensed prescriber. Federal law under Section 503A of the Federal Food, Drug, and Cosmetic Act permits traditional compounding pharmacies to prepare individualized preparations when certain conditions are met [4]. Wisconsin's Pharmacy Practice Act aligns with federal 503A requirements, meaning the pharmacy must be licensed by the Wisconsin Pharmacy Examining Board, the prescription must be patient-specific (not batch-manufactured for general sale), and the compound must not be a copy of a commercially available drug unless there is a documented clinical reason.

503A vs. 503B: What Wisconsin Patients Need to Know

503A pharmacies compound for individual patients on a prescription basis. 503B outsourcing facilities compound in larger batches for healthcare facilities. Most Wisconsin patients obtaining compounded progesterone for personal HRT use will go through a 503A pharmacy. The FDA's guidance on 503A compounding is available at fda.gov.

The key legal condition: a compounding pharmacy cannot prepare micronized progesterone capsules that are essentially copies of commercially available Prometrium without a documented clinical justification. If a licensed 200 mg micronized progesterone generic is available, the prescriber must document why the compounded version is medically necessary. A peanut allergy, a dose not available commercially (e.g., 150 mg), or a required oil-free formulation are accepted justifications.

Clinical Evidence for Oral Micronized Progesterone

The PEPI trial (Postmenopausal Estrogen/Progestin Interventions, N=875, published in JAMA 1995) remains the most cited randomized controlled trial establishing that oral micronized progesterone combined with conjugated equine estrogen produced a more favorable HDL-cholesterol profile than medroxyprogesterone acetate (MPA) in postmenopausal women [5]. That finding contributed to clinician preference for micronized progesterone in HRT regimens. A 2019 systematic review published in Climacteric examined cardiovascular and breast safety signals across progestogen types and found that oral micronized progesterone showed a more neutral breast cancer risk signal compared with synthetic progestins, though the authors noted the evidence remains observational [6].

The WHI (Women's Health Initiative) trials used MPA, not micronized progesterone. Applying WHI cardiovascular and breast-cancer findings directly to micronized-progesterone regimens is not supported by the trial design. The North American Menopause Society (NAMS) 2022 position statement on hormone therapy acknowledges this distinction explicitly [7].

Can I Get a Prometrium Prescription via Telehealth in Wisconsin?

Wisconsin permits telehealth prescribing of Prometrium and generic micronized progesterone. A licensed Wisconsin prescriber (MD, DO, APNP, or PA-C with prescriptive authority) may evaluate a patient via audio-video telehealth and issue a valid prescription for a Schedule-uncontrolled medication such as progesterone without a prior in-person visit, provided the clinical standard of care is met.

Ryan Haight Act and Progesterone

The Ryan Haight Act restricts telemedicine prescribing of controlled substances but does not apply to progesterone. Progesterone is not classified as a controlled substance under federal or Wisconsin law, so telehealth prescribers face no DEA telemedicine special-registration requirement for this drug [8].

What a Telehealth Evaluation Should Include

A clinically appropriate telehealth evaluation for Prometrium should cover:

• Menstrual or menopausal history
• Presence or absence of uterus (hysterectomy status)
• Current estrogen use (if prescribing for endometrial protection)
• Contraindications: undiagnosed vaginal bleeding, hepatic impairment, history of thromboembolic disease, known or suspected progesterone-sensitive cancer
• Baseline symptom assessment

The prescriber should document the clinical rationale in the chart. Wisconsin telehealth platforms licensed under the state's telehealth statute (Wis. Stat. § 49.45(61)) are permitted to collect this information and transmit the prescription electronically to any Wisconsin-licensed pharmacy.

How to Get the Lowest Prometrium Price in Wisconsin

Several strategies reliably reduce out-of-pocket costs for Wisconsin patients.

Manufacturer Savings Programs

AbbVie (which markets Prometrium) has historically offered a savings card for commercially insured patients. The card is not valid for patients using Medicare, Medicaid, or any federal health program. Eligible patients may pay as little as $0 per fill for brand Prometrium up to an annual cap. Program terms change annually; verify current terms at the AbbVie patient assistance page or by calling 1-800-255-5162.

GoodRx and Pharmacy Discount Cards

GoodRx, RxSaver, and NeedyMeds publish real-time discount prices at Wisconsin pharmacies. In January 2026, GoodRx prices for generic micronized progesterone 200 mg (30 capsules) at Wisconsin pharmacies ranged from $18 at Costco (membership required) to $52 at some independent pharmacies. Price variation across ZIP codes in Wisconsin is real. Pharmacies in Milwaukee, Madison, Green Bay, and Kenosha tend to show stronger competition and lower GoodRx prices than rural pharmacies in the Northwoods or Door County.

90-Day Supplies

Requesting a 90-day supply instead of a 30-day supply reduces per-unit dispensing fees. Mail-order pharmacies often apply an additional discount for 90-day fills. Wisconsin's ForwardHealth program allows 90-day supplies for maintenance medications, so Medicaid patients should confirm this option with their pharmacist.

Patient Assistance Programs

AbbVie's myAbbVie Assist program provides free or reduced-cost Prometrium to uninsured or underinsured patients who meet income eligibility criteria (generally at or below 400% of the federal poverty level). Applications are available at AbbVie.com or through a prescriber's office.

The HealthRX clinical team uses a four-step cost-minimization framework for Wisconsin progesterone patients: (1) Confirm generic micronized progesterone is medically appropriate; (2) check GoodRx prices at three or more local pharmacies before filling; (3) request a 90-day supply at first fill if the dose is established; (4) if out-of-pocket cost still exceeds $30 per month, evaluate 503A compounding with documented clinical justification or apply for AbbVie patient assistance.

Clinical Rationale for Micronized Progesterone in HRT

Understanding why Prometrium is prescribed, and the evidence behind it, helps patients engage in informed conversations with their Wisconsin prescribers.

Endometrial Protection in Postmenopausal Women

Estrogen-only hormone therapy in women with an intact uterus causes endometrial hyperplasia and increases endometrial carcinoma risk. Adding progesterone (or a synthetic progestin) prevents this. The FDA-approved indication for Prometrium in this setting is 200 mg orally at bedtime for 12 days per 28-day cycle when used cyclically with conjugated estrogen [9].

A continuous combined regimen (100 mg daily) is also commonly used off-label to avoid scheduled bleeding, particularly in postmenopausal women more than two years from last menses. The ACOG Practice Bulletin No. 141 discusses both cyclical and continuous regimens, noting that continuous combined therapy reduces withdrawal bleeding and is often preferred by patients [3].

Secondary Amenorrhea

Prometrium 400 mg at bedtime for 10 days is FDA-approved for secondary amenorrhea. This indication is less often the focus of cost discussions in Wisconsin, but the same pricing and insurance rules apply.

Sleep and Off-Label Uses

Oral micronized progesterone at bedtime is associated with sedation through neurosteroid (allopregnanolone) activity at GABA-A receptors. Some clinicians use this property intentionally, prescribing the dose at night to assist with sleep in perimenopausal women. This is an off-label use. A small randomized crossover trial (N=40) published in Menopause in 2012 found that 300 mg oral micronized progesterone at bedtime improved polysomnographic sleep quality in menopausal women compared to placebo (P<0.05) [10]. Wisconsin insurers do not uniformly cover Prometrium for a sleep indication alone; the primary HRT indication is the most defensible for PA documentation.

Breast Cancer Risk Profile Compared to Synthetic Progestins

Several large observational studies, including the E3N cohort (N=80,377, published in Breast Cancer Research and Treatment), found that combined estrogen plus micronized progesterone did not significantly increase breast cancer risk over five years, while synthetic progestins did increase risk in the same cohort [11]. These findings are hypothesis-generating, not definitive, because observational data cannot establish causation. The NAMS 2022 position statement urges clinicians to discuss the distinction between progestogen types with patients, noting that "the type of progestogen may affect risk" while acknowledging the observational study design limitations [7].

A Cochrane review of hormone therapy for menopausal symptoms (2017, updated search 2022) found that progesterone-containing regimens reduced vasomotor symptom frequency relative to placebo but noted heterogeneity across trials that limits precise effect estimates [12].

Pharmacokinetics: Why Oral Administration at Bedtime Matters

Oral micronized progesterone undergoes extensive first-pass hepatic metabolism. Peak serum progesterone occurs approximately two to three hours after ingestion, with a half-life of roughly 16 to 18 hours for the parent compound. Taking the capsule at bedtime with food increases bioavailability by approximately 173% compared to fasting, according to the Prometrium prescribing information archived at the FDA Drugs@FDA database [9]. Wisconsin prescribers should document "take with food at bedtime" explicitly on the prescription to avoid under-dosing from fasting administration.

Wisconsin-Specific Pharmacy Resources

State Board of Pharmacy Verification

Before filling at a compounding pharmacy, Wisconsin patients can verify licensure through the Wisconsin Department of Safety and Professional Services (DSPS) pharmacy license lookup at dsps.wi.gov. Any pharmacy compounding micronized progesterone must hold a current Wisconsin pharmacy license and, ideally, PCAB accreditation from the Pharmacy Compounding Accreditation Board.

Wisconsin SeniorCare and ADRC Programs

Wisconsin's SeniorCare program (for residents age 65 and older) provides prescription drug assistance to enrollees not eligible for Medicare Part D. SeniorCare covers medications including progesterone products at negotiated rates with a deductible structure. Wisconsin residents can apply through their local Aging and Disability Resource Center (ADRC). The Wisconsin DHS program page provides current enrollment criteria [13].

340B Program Access

Federally Qualified Health Centers (FQHCs) and certain other safety-net clinics in Wisconsin participate in the 340B Drug Pricing Program, which allows them to purchase Prometrium at significantly reduced acquisition costs and pass savings to patients. Patients seen at qualifying Wisconsin clinics, including those in Milwaukee (e.g., Journey Mental Health, Community Health Centers), Madison (e.g., Access Community Health Centers), and Green Bay, may access 340B pricing. The HRSA 340B program database allows patients to find covered entities at hrsa.gov.

Telehealth Platforms Operating in Wisconsin

Several telehealth platforms prescribe and coordinate pharmacy fulfillment for Prometrium in Wisconsin. HealthRX and comparable platforms perform audio-video evaluations, transmit electronic prescriptions to Wisconsin-licensed pharmacies of the patient's choice, and can apply GoodRx or AbbVie savings cards at point of sale. Wisconsin's telehealth parity law requires most commercial insurers to reimburse covered telehealth visits at rates comparable to in-person visits, reducing the cost of the initial consultation.

Dosing Reference for Wisconsin Prescribers and Patients

| Indication | FDA-Approved Dose | Timing | |---|---|---| | Endometrial protection with estrogen (cyclical) | 200 mg orally at bedtime | 12 days per 28-day cycle | | Endometrial protection with estrogen (continuous) | 100 mg orally at bedtime | Daily (off-label for continuous use) | | Secondary amenorrhea | 400 mg orally at bedtime | 10 days |

All doses should be taken with food to maximize bioavailability. The FDA prescribing information specifies that a meal increases peak progesterone Cmax by approximately 173% relative to fasting [9]. Wisconsin pharmacists routinely counsel patients on this; if the dispensing label does not specify "take with food," ask the pharmacist to add that instruction.