UNIFIED IPA CONTRACEPTIVE AND INFERTILITY MEDICATION FORMULARY Effective January 1, 2016 I. CONTRACEPTIVES COVERED WITHOUT MEMBER CO-PAY ARANELLE TAB AVIANE TAB AZURETTE TAB 28 DAY CAMILA TAB 0.35MG CAZIANT PAK CESIA PAK CHATEAL TAB 0.15/30 CRYSELLE-28 TAB 28 TABS CYCLAFEM TAB 1/35 CYCLAFEM TAB 7/7/7 DASETTA TAB 1/35 DASETTA TAB 7/7/7 DROSPIR/ETHI TAB 3-0.03MG ELINEST TAB EMOQUETTE TAB ENPRESSE-28 TAB ERRIN TAB 0.35MG FALMINA TAB GIANVI TAB 3-0.02MG GILDESS FE TAB 1.5/30 GILDESS FE TAB 1/20 GILDESS TAB 1.5/30 GILDESS TAB 1/20 HEATHER TAB 0.35MG INTROVALE TAB JOLESSA TAB JOLIVETTE TAB 0.35MG JUNEL 1.5/30 TAB JUNEL 1/20 TAB JUNEL FE TAB 1.5/30 JUNEL FE TAB 1/20 KARIVA TAB 28 DAY KELNOR TAB 1/35 KURVELO TAB 0.15/30 LEENA TAB LESSINA TAB LEVONEST TAB LEVONOR/ETHI TAB ESTRADIO LEVONOR/ETHI TAB ESTRADIO LEVONOR/ETHI TAB ESTRADIO LEVONORGESTR TAB 0.75MG LEVONORGESTR TAB 1.5MG LEVORA-28 TAB 0.15/30 LOMEDIA 24 TAB FE LORYNA TAB 3-0.02MG LOW-OGESTREL TAB LUTERA TAB MARLISSA TAB 0.15/30 MEDROXYPR AC INJ 150MG/ML MONO-LINYAH TAB 0.25-35 MONONESSA TAB MYZILRA TAB NECON TAB 0.5/35 NECON TAB 1/35 NECON TAB 1/50-28 NECON TAB 7/7/7 NORA-BE TAB 0.35MG NORETH/ETHIN CHW FE NORETHINDRON TAB 0.35MG NORGEST/ETHI TAB 0.25/35 NORGEST/ETHI TAB ESTRADIO NORTREL TAB 0.5/35 NORTREL TAB 1/35 NORTREL TAB 7/7/7 OCELLA TAB 3-0.03MG OGESTREL TAB ORSYTHIA TAB PORTIA-28 TAB PREVIFEM TAB QUASENSE TAB RECLIPSEN TAB SOLIA TAB SPRINTEC 28 TAB 28 DAY SRONYX TAB SYEDA TAB 3-0.03MG TILIA FE TAB TRI-LINYAH TAB TRINESSA TAB TRI-PREVIFEM TAB TRI-SPRINTEC TAB TRIVORA-28 TAB VELIVET PAK VESTURA TAB 3-0.02MG VIORELE TAB WERA TAB 0.5/35 XULANE DIS 150-35 ZARAH TAB 3-0.03MG ZENCHENT FE CHW 0.4MG-35 ZENCHENT TAB ZOVIA 1/35E TAB ZOVIA 1/50E TAB NUVARING MIS LO LOESTRIN TAB LO MINASTRIN PAK FE MINASTRIN 24 CHW FE QUARTETTE TAB ELLA TAB 30MG NATAZIA TAB NECON TAB 10/11-28
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