Contraceptives
Showing 1–12 of 177 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
|---|---|---|---|---|---|
|
Tri-Lo-Sprintec Tabs 0.18/0.215/0.25 Mg-25 Mcg |
Contraceptives |
1 |
Generic |
$14 |
|
|
Ortho Tri-Cyclen (28) Tabs 0.18/0.215/0.25 Mg-35 Mcg (Brand) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Tri-Mili Tabs 0.18/0.215/0.25 Mg-35 Mcg |
Contraceptives |
1 |
Generic |
$14 |
|
|
Trinessa (28) Tabs 0.18/0.215/0.25 Mg-35 Mcg |
Contraceptives |
1 |
Generic |
$14 |
|
|
Tri-Previfem Tabs 0.18/0.215/0.25 Mg-35 Mcg |
Contraceptives |
1 |
Generic |
$14 |
|
|
Tri-Sprintec Tabs 0.18/0.215/0.25 Mg-35 Mcg |
Contraceptives |
1 |
Generic |
$14 |
|
|
Tri-Vylibra Tabs 0.18/0.215/0.25 Mg-35 Mcg |
Contraceptives |
1 |
Generic |
$14 |
|
|
Tri-Estarylla Tabs 0.18/0.215/0.25 Mg-35 Mcg |
Contraceptives |
1 |
Generic |
$14 |
|
|
Estarylla Tabs 0.25-35 Mg-Mcg (Brand) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Femynor Tabs 0.25-35 Mg-Mcg (Brand) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Mili Tabs 0.25-35 Mg-Mcg (Brand) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Mononessa Tabs 0.25-35 Mg-Mcg (Brand) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Norgestimate-Eth Estradiol Tabs 0.25-35 Mg-Mcg (Brand) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Sprintec 28 Tabs 0.25-35 Mg-Mcg (Brand) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Vylibra Tabs 0.25-35 Mg-Mcg (Brand) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Previfem Tabs 0.25-35 Mg-Mcg (Brand) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Cryselle-28 Tabs 0.3-30 Mg-Mcg |
Contraceptives |
1 |
Generic |
$14 |
|
|
Low-Ogestrel Tabs 0.3-30 Mg-Mcg |
Contraceptives |
1 |
Generic |
$14 |
|
|
Etonogestrel-Ethinyl Estradiol Ring (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Norgestrel & Ethinyl Estradiol Tabs (Generic) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Norethindrone (Contraceptive) Tabs .35Mg (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Norgestimate-Ethinyl Estradiol (Triphasic) Tabs 0.18/0.215/0.25 Mg-35 Mcg (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Norgestimate-Ethinyl Estradiol (Triphasic) Tabs 0.18/0.215/0.25 Mg-25 Mcg (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Norgestimate-Ethinyl Estradiol Tabs 0.25-35 Mg-Mcg (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Norethindrone & Eth Estradiol Tabs 1-35 Mg-Mcg (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Norethindrone-Eth Estradiol (Triphasic) Tabs 0.5/0.75/1-35 Mg-Mcg (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Lactic Acid-Citric Acid-Potassium Bitartrate Gel 1.8-1-0.4% (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Levonorgestrel-Ethinyl Estradiol (91-Day) Tabs 42-21-21-7 Days (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Drospirenone-Ethinyl Estradiol-Levomefolate Calcium Tabs (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Levonorgestrel-Ethinyl Estradiol (91-Day) Tabs 0.15-0.03 &0.01 Mg (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Norethindrone-Eth Estradiol (Triphasic) Tabs (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Levonorgestrel-Ethinyl Estradiol Patch 120-30 Mcg/24Hr (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Norelgestromin-Ethinyl Estradiol Ptwk (Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |
|
|
Ethinyl estradiol 35 mcg and norelgestromin 150 mcg per day (Generic) |
Contraceptives |
1 |
Generic |
$14 |
|
|
Drospirenone-Ethinyl Estradiol Tabs 3-0.03 Mg(Generic) |
Contraceptives |
3 |
Non-Formulary Brand |
$68 |