Cost without Insurance: $408 for first month (18-pack) and $186/mo after (8-pack).
Cost with Insurance: ~$60/mo - ~$77/mo (8-pack).
Apply to Novo Nordisk's Patient Assistance Program with proof of income and you may get a three month's supply for free.
Many major insurance plans no longer cover Vagifem as of 2019.
The cost of Vagifem has more than doubled in the past five years - New York Times