OBJECTIVES: Among the two most frequently prescribed forms of vaginal estrogen (VE), acceptability of tablets has been shown to be greater than creams in clinical trials.  However, creams are more often prescribed.  This study examines the association between form of VE and initial prescription refill rate and treatment duration among Medicaid enrollees.  METHODS: A retrospective cohort study was conducted using North Carolina Medicaid claims January 2003 to December 2007 of women ages 18-64 with a new VE prescription claim.  Multiple logistic regression was performed to assess the association of VE form and initial prescription refill among women with 1 year post-index continuous enrollment; OLS regression was used to assess treatment duration over 2 years follow-up.  Demographic factors included age and race.  Additional covariates:  Charlson-Deyo comorbidity index, number of outpatient visits, mammography, and systemic estrogen use in the pretreatment year, and index year.  RESULTS: A total of 1812 patients prescribed VE (mean age 49.4±10.5, 30.9% black) having 1 year follow-up were identified; 465 women had 2 years follow-up. 89.6% received cream; 10.4% tablets.  Initial prescription refill rate was 48.7% for tablets, 33.7% for cream (p<0.001).  Average treatment duration among women with 1+ refill and 2 years follow-up was longer for tablets than cream (291.7±214.3 days versus 281.8±226.3; p=0.745).  Tablet users were significantly more likely to refill their initial prescription (OR 1.88, 95%CI=1.38-2.56).  OLS regression results showed no significant difference in treatment duration for tablets vs. cream (beta=17.53, 95%CI=-42.56-77.62).  CONCLUSIONS: This analysis of Medicaid claims showed tablet users were significantly more likely to refill their initial prescription than cream users.  During 2 years of follow-up, treatment duration among those who refilled at least once was longer for tablet users, although not significant.  These results give some real world support for women’s greater acceptability of vaginal tablets to creams.