Favor (formerly The Pill Club): Who Should Avoid It and Why

What Is Favor, and Is It Actually Legit?

Favor, which operated as The Pill Club from 2016 until rebranding in late 2023, is a licensed telehealth platform that prescribes and ships hormonal contraception directly to your door. The short answer on legitimacy: yes, it holds pharmacy licenses across participating states and employs licensed providers. The longer answer is more nuanced.

LegitScript, the pharmacy verification service used by Google and the FDA to flag rogue online pharmacies, does not list Favor among its certified pharmacies as of January 2025. That does not mean Favor is operating illegally. State pharmacy board licensure and LegitScript certification are separate tracks. LegitScript certification is voluntary, and many legitimate telehealth pharmacies have not pursued it. What it does mean is that you cannot verify Favor through that specific third-party channel the way you can verify, say, a chain retail pharmacy.

The FDA's BeSafeRx program outlines what makes an online pharmacy safe: a valid U.S. Pharmacist, a prescription requirement, and a physical U.S. Address. Favor meets all three of those criteria on paper.

The BBB Complaint Picture

Where the legitimacy question gets complicated is on the Better Business Bureau profile. As of late 2024, Favor (operating under The Pill Club's BBB listing) carries an F rating based on more than 200 filed complaints. The most common complaint categories are:

• Billing errors and double charges
• Prescription delays causing a gap in pill supply
• Difficulty canceling subscriptions
• Insurance coordination failures leading to unexpected out-of-pocket charges

An F BBB rating does not mean a business is fraudulent. It means the BBB found the company's complaint response record inadequate relative to the volume of complaints. For a contraceptive service where a billing error can mean your pills don't ship on time, that distinction matters clinically. A week without pills mid-pack substantially raises your failure-rate risk.

State Regulatory Standing

Favor is not on any FDA enforcement action list as of this writing. No state pharmacy board has issued a public suspension of Favor's dispensing license. That is the floor, not an endorsement. Women in states with stricter telehealth prescribing rules (Texas, for example, has specific synchronous-visit requirements for certain telehealth prescriptions) should verify that Favor's asynchronous questionnaire model satisfies state law for their location before relying on it.

Specific Patient Profiles Who Should Avoid Favor

This is the core question, and it deserves a direct answer organized by clinical situation rather than vague warnings.

Women With Complex Cardiovascular or Clotting History

ACOG Practice Bulletin No. 206 classifies combined estrogen-progestin contraceptives as Category 4 (unacceptable health risk, method should not be used) for women with:

• A personal history of deep vein thrombosis or pulmonary embolism
• Known thrombogenic mutations such as Factor V Leiden or prothrombin G20210A
• Current ischemic heart disease
• History of stroke

Favor's intake model is an asynchronous questionnaire. A trained clinician reviews your answers, but there is no video visit, no physical exam, no auscultation, and no point-of-care blood pressure measurement. Women with any of the above histories should receive contraceptive counseling in a setting where the provider can perform a full risk-benefit assessment, review actual lab results, and document an individualized plan. A checkbox form is not that setting.

Women with migraines with aura fall into the same category. Estrogen-containing contraceptives are contraindicated in migraine with aura because of stroke risk, a WHO Medical Eligibility Criteria Category 4 designation. WHO MEC 2015 is explicit on this point. If your migraine diary shows aura and you answer a questionnaire about it honestly, a competent asynchronous reviewer should decline to prescribe combined pills, but you have no guarantee that the nuance of your symptom description will be caught. Go to a provider who can ask follow-up questions in real time.

Women With Hypertension, Controlled or Uncontrolled

Blood pressure above 140/90 mmHg is a WHO MEC Category 3 or 4 contraindication for combined hormonal contraceptives, depending on severity. Favor cannot measure your blood pressure. If you enter a self-reported normal reading and it is not accurate, you may receive a combined pill that raises your cardiovascular risk.

A 2022 analysis published in Obstetrics and Gynecology found that telehealth contraceptive platforms that rely on self-reported blood pressure substantially under-detect hypertension compared to in-person measurement. Women with any history of elevated readings, those with obesity (BMI <30 is not a contraindication, but BMI above 35 with combined pills carries a Category 2 designation), or those on antihypertensives should see a provider who can actually verify their current BP before starting or continuing estrogen-containing contraception.

Women Who Are Postpartum or Breastfeeding

Postpartum contraception is one of the highest-stakes prescribing situations in reproductive health, and timing matters down to the week.

ACOG Practice Bulletin No. 219 states combined hormonal contraceptives (pills, patch, ring) are contraindicated in the first 21 days postpartum for all women because of elevated postpartum venous thromboembolism risk. From 21 to 42 days, they may be used only if no other VTE risk factors are present. Women who are exclusively breastfeeding should not use combined hormonal contraceptives before 6 weeks postpartum, and use between 6 weeks and 6 months is a Category 3 designation where the risks generally outweigh the benefits.

Progestin-only pills (the "mini-pill"), the hormonal IUD, and the implant are all appropriate for immediate postpartum and breastfeeding use. If Favor is your plan for postpartum contraception, the specific timing of your delivery and your breastfeeding status must be accurately captured in the questionnaire, and you need to be confident the reviewing clinician will match method to week. Given the billing and prescription error complaints on record, this is not an ideal setting for a situation where the wrong pill type at week 3 postpartum carries real thrombosis risk.

Women in Perimenopause Who Need More Than a Pill

Favor's service is built around contraception delivery, not around the hormonal complexity of the perimenopausal transition. If you are in your mid-to-late 40s, your primary needs may be FSH and estradiol testing, discussion of vasomotor symptoms, bone density context, or Menopause Society (NAMS) 2023 position statement guidance on menopausal hormone therapy options.

Low-dose combined oral contraceptives are legitimately used in perimenopausal women for cycle regulation and contraception through menopause confirmation (defined as 12 consecutive months of amenorrhea), but this should happen alongside a conversation about the transition, not as a standalone pill refill. Favor does not offer that broader evaluation.

If you are perimenopausal and your primary concern is still contraception (not symptom management), Favor may still work for straightforward pill refills. However, if you are also experiencing hot flashes, sleep disruption, cognitive changes, or irregular bleeding that suggests anovulation rather than structural pathology, you need a provider who can address the full picture.

Women Who Need Non-Hormonal or Long-Acting Methods

Favor does not place IUDs. It does not perform implant insertions. If your medically preferred method is a copper IUD (fully non-hormonal, highly effective, and a preferred LARC option per ACOG), Favor cannot help you get it. The same applies to the hormonal implant (Nexplanon).

Women who cannot use estrogen and do not want a daily pill, women who have had failures on oral contraceptives due to adherence challenges, and women whose reproductive plans are shifting (trying to conceive within 6-12 months, for example, where a LARC with fast return-to-fertility like the implant may be ideal) should go directly to an OB-GYN or reproductive health clinic.

Women With Active Liver Disease or Certain Medications

Combined hormonal contraceptives are metabolized hepatically and are generally contraindicated in active liver disease, hepatic adenoma, or malignant hepatoma. Women on enzyme-inducing medications, including rifampin, certain antiepileptics (phenytoin, carbamazepine, topiramate at higher doses), and some antiretrovirals, may have significantly reduced contraceptive efficacy with combined pills. A telehealth questionnaire that does not explicitly probe for all current medications with specific attention to enzyme inducers may miss this interaction entirely.

If you are on any of the above medication classes, or if you have any history of liver disease, you need a pharmacist or prescribing clinician who can run a full interaction check and potentially adjust method or dose accordingly.

Women With a History of Billing or Prescription Errors With Favor

This is a practical rather than clinical reason to avoid the service, but it is worth naming directly. Given the documented complaint pattern at the BBB, women who have previously experienced:

• A prescription sent in the wrong formulation
• A billing dispute that was not resolved within one billing cycle
• A shipment delay that caused a mid-pack gap

Should not return to the same service for ongoing contraception without a documented resolution. A missed pill week mid-cycle carries a typical-use failure rate context worth understanding: combined oral contraceptives have a typical-use failure rate of approximately 9% per year, and inconsistent use is the primary driver of that figure.

Pregnancy and Lactation Safety: What Favor Prescribes and What You Need to Know

Every contraceptive method Favor prescribes carries pregnancy and lactation considerations that a woman should understand before starting, regardless of where she obtains her prescription.

Combined Hormonal Contraceptives (Pill, Patch, Ring)

These are not teratogenic at the dose levels used in modern contraception, but ACOG guidance recommends stopping them as soon as pregnancy is confirmed. There is no established fetal harm from inadvertent first-trimester exposure to low-dose combined pills, but no reason to continue them once pregnancy is known.

Lactation transfer: ethinyl estradiol passes into breast milk in small amounts and may reduce milk supply, particularly in the early weeks when supply is being established. This is why combined pills are contraindicated before 6 weeks postpartum in breastfeeding women and carry a Category 3 designation from 6 weeks to 6 months, per WHO MEC.

Progestin-Only Pills (Mini-Pill)

Norethindrone-based progestin-only pills, which Favor does prescribe, are considered safe during lactation. CDC US MEC rates progestin-only pills as Category 1 (no restriction) for breastfeeding women at any time postpartum. Progestin transfer into milk is minimal and has not been shown to affect infant growth or development in clinical studies.

If you are postpartum and breastfeeding and want to use Favor for a progestin-only pill, that is a medically appropriate option provided your questionnaire accurately captures your postpartum week, your breastfeeding status, and the absence of the cardiovascular risk factors listed above. Be exact in what you report.

Contraception Requirement Framing

None of the methods Favor prescribes are teratogenic in the way that, say, isotretinoin or valproate are. There is no mandatory dual-contraception or pregnancy test requirement built into the service model. However, if you are switching methods, the CDC US MEC quick start guidance recommends a pregnancy test before initiating if there is any possibility of pregnancy, and back-up contraception for 7 days when starting most hormonal methods mid-cycle.

Evidence Gap: What We Don't Know About Favor's Clinical Outcomes

Women deserve transparency here. As of January 2025, there is no published peer-reviewed study on clinical outcomes, adverse event rates, or prescribing accuracy specific to Favor or its predecessor The Pill Club. Most of what is known comes from consumer complaints, press coverage of a 2021 Department of Labor investigation into company practices (which focused on employee and provider relations rather than patient outcomes), and general telehealth contraception literature.

The broader telehealth contraception literature is more informative. A 2021 JAMA Internal Medicine study (Ramesh et al., 2021) found that asynchronous telehealth contraception platforms appropriately screened out women with medical contraindications in the majority of cases, but the miss rate for self-reported hypertension was a meaningful limitation. Women with contraindications who self-reported inaccurately or incompletely were still prescribed combined pills in a subset of cases.

This is not a Favor-specific finding. It is a structural limitation of asynchronous care that applies to the entire category of questionnaire-based contraceptive telehealth. Know that limitation before you use any platform in this space.

Who Favor Works Well For

To be balanced: Favor is a reasonable option for a specific profile of woman.

You are a good candidate if:

• You are between 18 and 35, with no cardiovascular risk factors and no history of VTE, stroke, or migraine with aura
• You have already been evaluated in person and want a convenient refill pathway for a method your provider already selected for you
• Your insurance is accepted and you have confirmed it before relying on the service
• You live in a state where Favor's asynchronous model is fully compliant with telehealth prescribing law
• You do not need a LARC, a non-hormonal method, or an in-person procedure

You are not a good candidate if you fit any of the clinical profiles above, or if you need comprehensive reproductive health care that extends beyond the pill refill itself.

Practical Steps If Favor Is Not Right for You

If you have read through the profiles above and recognized yourself, here is where to go instead:

1. Planned Parenthood clinics offer sliding-scale contraceptive care including IUD and implant insertion.
2. Your OB-GYN or family medicine provider can prescribe any method and assess cardiovascular risk in person.
3. ACOG's find-a-provider directory lists board-certified OB-GYNs by ZIP code.
4. For breastfeeding-specific contraception questions, a certified lactation consultant (IBCLC) working alongside your OB-GYN is the right team.
5. Telehealth platforms that offer synchronous video visits (live video with a provider) provide a higher level of assessment than asynchronous questionnaire models for complex cases.

If Favor has billed you incorrectly or failed to ship a prescription on time, document the issue in writing to both Favor's customer service and your state pharmacy board. The FDA MedWatch program (fda.gov/safety/medwatch) accepts reports of medication errors, including dispensing errors from online pharmacies.