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What makes the Liletta IUD different from Mirena?

Here’s what you and your patients should know about these two (very similar) hormonal IUDs.

by Jessica Morse, MD, MPH

published 02/23/17

Many of you are likely already stocking and placing Liletta, the levonorgestrel intrauterine system (IUS, a.k.a. IUD) introduced in 2015. But you and your patients may still be trying to sort out how Liletta is different from—or very similar to—another IUD that’s been out there for years, the Mirena. Here are the details.

How long does Liletta actually last?

As of early 2017, the official word from the FDA is that Liletta effectively prevents pregnancy for up to three years. But that’s just a start. Liletta was designed to last seven years, and the study testing its effectiveness will be ongoing through 2020. To date, the study has shown that the pregnancy rate is very low (0.55%) for up to three years of use. Another study looking at the amount of levonorgestrel released by the IUS through five years of use suggests that it’s on track for a seven-year lifespan.

So what can you tell your patients now? You can reassure them that if they reach the three-year mark and want to keep their Liletta, the FDA will likely have approved a longer lifespan by that time.

How easy is Liletta to place?

The early adopters out there may remember that the original Liletta inserter was a bit clunky—sort of a hybrid between other inserters we love or hate. The new inserter, now widely available, is remarkably similar to the inserters you’re used to with other hormonal IUDs. Liletta’s inserter even has numbers on it to remind you of the steps for placement. Although the slider is a bit stiff, the placement process will be very familiar to anyone who has placed a hormonal IUD in the past. It’s also easily learned by a new health care provider. At the time of writing, there are a bunch of webinars about the new inserter coming up, and lots of other training resources you can access on your own time.

How should I counsel my patients about Mirena versus Liletta?

In terms of the patient experience of the device, the truth is that they are likely the same. Both are excellent at preventing pregnancy, and both are likely to cause noticeable decreases in menstrual bleeding or even complete cessation. The amount of levonorgestrel delivered is basically the same over the first five years, resulting in similar side effect and benefit profiles. Even the inserters and placement processes are now similar. From your patient’s perspective, the biggest difference between the two may be the cost.

How much will my patient pay for a Liletta?

Cost is the only place where there may be a profound difference between the two devices. Liletta is the result of a unique partnership with women’s health advocates, researchers, and a not-for-profit drug company to develop an affordable IUD. Throughout the process, Liletta’s makers have been committed to ensuring the device is broadly accessible, even to those without health insurance and those with high deductibles. Their goal is that no one will ever have to pay more than $150 for a Liletta. That’s right: for the price of a nice dinner out, your patient could get a method to protect her from unintended pregnancy for years. On the other hand, from the perspective of a patient with a health insurance plan that covers birth control with no co-pays, even this aspect of the two devices will be the same!

How do I get reimbursed for Liletta?

If your practice should be reimbursed by a third-party payer for a Liletta, there is now a J-code specific to this IUD. For additional tips on reimbursement and coding, check out this comprehensive resource: Intrauterine Devices & Implants: a Guide to Reimbursement.

Overall, Liletta is a welcome option for patients interested in hormonal contraception. As a provider, I feel good about being able to offer patients who want an IUD an effective, safe, and affordable option—regardless of their health care coverage.

Jessica Morse is an ob/gyn at Duke University where she works with residents providing a full spectrum of reproductive health care. Her main research interest is increasing the number of women who know about long-acting reversible contraceptives (IUDs and implants), in the U.S., Uganda, Rwanda and Honduras. She lives in Durham, NC, with her husband and silly 3-year-old son, where they spend weekends hiking, hanging out at playgrounds, and exploring the Bull City.
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