1. No category

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