All *CONTRACEPTIVES*

Afirmelle Tablet 0.1-20 MG-MCG Oral
Afirmelle Tablet 0.1-20 MG-MCG Oral

Levonorgestrel-Ethinyl Estrad

Tier: 1
PA Type: No Prior Authorization
ST: N
Afirmelle Tablet 0.1-20 MG-MCG Oral
Afirmelle Tablet 0.1-20 MG-MCG Oral

Levonorgestrel-Ethinyl Estrad

Tier: 1
PA Type: No Prior Authorization
ST: N
Altavera Tablet 0.15-30 MG-MCG Oral
Altavera Tablet 0.15-30 MG-MCG Oral

Levonorgestrel-Ethinyl Estrad

Tier: 1
PA Type: No Prior Authorization
ST: N
Altavera Tablet 0.15-30 MG-MCG Oral
Altavera Tablet 0.15-30 MG-MCG Oral

Levonorgestrel-Ethinyl Estrad

Tier: 1
PA Type: No Prior Authorization
ST: N
Altavera Tablet 0.15-30 MG-MCG Oral
Altavera Tablet 0.15-30 MG-MCG Oral

Levonorgestrel-Ethinyl Estrad

Tier: 1
PA Type: No Prior Authorization
ST: N
Alyacen 1/35 Tablet 1-35 MG-MCG Oral
Alyacen 1/35 Tablet 1-35 MG-MCG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alyacen 1/35 Tablet 1-35 MG-MCG Oral
Alyacen 1/35 Tablet 1-35 MG-MCG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alyacen 7/7/7 Tablet 0.5/0.75/1-35 MG-MCG Oral
Alyacen 7/7/7 Tablet 0.5/0.75/1-35 MG-MCG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Alyacen 7/7/7 Tablet 0.5/0.75/1-35 MG-MCG Oral
Alyacen 7/7/7 Tablet 0.5/0.75/1-35 MG-MCG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Amethia Lo TABLET 0.1-0.02 & 0.01 MG Oral
Amethia Lo TABLET 0.1-0.02 & 0.01 MG Oral

Levonorgest-Eth Estrad 91-Day

Tier: 1
PA Type: No Prior Authorization
ST: N
Amethia Lo TABLET 0.1-0.02 & 0.01 MG Oral
Amethia Lo TABLET 0.1-0.02 & 0.01 MG Oral

Levonorgest-Eth Estrad 91-Day

Tier: 1
PA Type: No Prior Authorization
ST: N
Amethia TABLET 0.15-0.03 &0.01 MG ORAL
Amethia TABLET 0.15-0.03 &0.01 MG ORAL

Levonorgest-Eth Estrad 91-Day

Tier: 1
PA Type: No Prior Authorization
ST: N