Medication Lookup

The results below have been sorted using a 2-tier plan. For the most accurate search results, check your plan details and choose another tier plan from the drop-down menu near the search bar.

BALCOLTRA (Eligible for $0 copay)

THERAPEUTIC CLASS: CONTRACEPTIVES*

TABS

Not Covered by a 3-Tier Plan

Learn more about tiers.

Note Title

Exceptions To Non Covered Medications

Definition

Your doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
Note Title

Eligible At No Cost

Definition

This medication is available through the pharmacy benefit at no cost ($0) to eligible members.

Covered Alternative Medications

ALTAVERA (Eligible for $0 copay)
APRI 28 (Eligible for $0 copay)
AVIANE 28 (Eligible for $0 copay)
AZURETTE 28 (Eligible for $0 copay)
BRIELLYN (Eligible for $0 copay)
CRYSELLE 28 (Eligible for $0 copay)
EMOQUETTE 28 (Eligible for $0 copay)
DASETTA 1/35 (Eligible for $0 copay)
DASETTA 7/7/7 (Eligible for $0 copay)
FALMINA (Eligible for $0 copay)
GENERESS FE
INTROVALE (Eligible for $0 copay)
KELNOR 1/35 (Eligible for $0 copay)
KELNOR 1/50 (Eligible for $0 copay)
JUNEL 1.5/30 (Eligible for $0 copay)
JUNEL 1/20 (Eligible for $0 copay)
LESSINA (Eligible for $0 copay)
LEVLITE -28
LEVONEST (Eligible for $0 co-pay)
LEVORA (Eligible for $0 copay)
LOESTRIN -1/20 (Eligible for $0 copay)
LOESTRIN -FE 1/20 (Eligible for $0 copay)
LOESTRIN 1.5/30 (Eligible for $0 copay)
LOESTRIN FE 1.5/30 (Eligible for $0 copay)
LORYNA (Eligible for $0 copay)
LOW-OGESTREL (Eligible for $0 copay)
LO/OVRAL
LUTERA (Eligible for $0 copay)
MICROGESTIN 1.5/30 (Eligible for $0 copay)
MARLISSA (Eligible for $0 copay)
MICROGESTIN 1/20 (Eligible for $0 copay)
MODICON 28 TABS
MONO-LINYAH (Eligible for $0 co-pay)
MONONESSA (Eligible for $0 copay)
NECON .5/35 21 (Eligible for $0 copay)
NECON .5/35 28 (Eligible for $0 copay)
NECON 1/35 21 (Eligible for $0 copay)
NECON 1/35 28 (Eligible for $0 copay)
NECON 1/50 21 (Eligible for $0 copay)
NECON 1/50 28 (Eligible for $0 copay)
NORDETTE 21 TABS
NORDETTE 28 TABS
NORTREL (Eligible for $0 copay)
ORTHO-CYCLEN 28
OGESTREL (Eligible for $0 copay)
ORTHO-CEPT 28 TABS
ORTHO-EVRA (Eligible for $0 co-pay)
ORTHO-NOVUM -1/35 28 TABS
ORSYTHIA (Eligible for $0 copay)
OVRAL -21
OVRAL -28
PHILITH (Eligible for $0 copay)
PORTIA (Eligible for $0 copay)
PREVIFEM (Eligible for $0 copay)
RECLIPSEN (Eligible for $0 copay)
SOLIA (Eligible for $0 copay)
SPRINTEC (Eligible for $0 copay)
SYEDA (Eligible for $0 copay)
YASMIN 28
VESTURA (Eligible for $0 copay)
WERA 28 (Eligible or $0 co-pay)
WYMZYA FE (Eligible for $0 co-pay)
XULANE (Eligible for $0 co-pay)
ZENCHENT (Eligible for $0 copay)
ZENCHENT FE (Eligible for $0 copay)
ZEOSA (Eligible for $0 copay)
ZOVIA 1/35E (Eligible for $0 copay)
ZOVIA 1/50E (Eligible for $0 copay)

Other Sites

Medication Lookup

TABS

Prior Authorization Forms

Important Information

Specialty Pharmacy

Alternatives to Opioids

For Federal Employee Program Members

Eligible Medicare Members

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