Affordable Care Act Covered Contraceptive Products
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- Stephen Franklin
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1 PHARMACY SERVICES Affordable Care Act Covered Contraceptive Products Find out if your medication is on the list We are committed to empowering you to know your coverage options for preventive care and make informed health care decisions. Under our Preventive Services benefit*, we cover options in each FDA approved contraceptive method category at no cost to you. Some contraceptives are available from a pharmacy (under your Prescription Medication Benefit ) while others are provided by your doctor (under your Medical Benefit ). Specifically, we cover generically available women s contraceptives. When no generic exists for an FDA-approved contraceptive method category, a brand-name women s contraceptive that is on our formulary will be covered at no cost to you. If your doctor believes that our covered contraceptives are medically inappropriate, you may request an exception by contacting Customer Service at the number listed on the back of your member ID card. *This benefit applies if you have coverage under the Affordable Care Act preventive benefit. Check your benefit booklet for coverage.
2 Contraceptives Available From a Pharmacy The following contraceptive products are available from an eligible retail pharmacy and will be processed under your pharmacy benefits with a prescription. Please see your health plan s website or contact Customer Service for information on eligible pharmacies. Over-The-Counter (OTC) products require a prescription from your doctor to be processed at no cost to you at the pharmacy. BARRIER METHODS: Condoms Female condom () Diaphragm Sponges Nonoxynol-9 containing Sponges, including Today Sponge () Cervical Cap Spermicide Nonoxynol-9 containing gel () NON-ORAL HORMONAL METHODS: Patch Xulane Vaginal Contraceptive Ring NuvaRing Shot/Injection Medroxyprogesterone acetate 150 mg/ml EMERGENCY CONTRACEPTION: Levonorgestrel-Containing Products Generic Products* for Plan B One-Step : Aftera, EContra EZ, Fallback Solo, Levonorgestrel 1.5mg, My Way, Next Choice One Dose, Opcicon One-Step, React 1.5mg, Take Action Ulipristal Acetate-Containing Products Ella *Note: Because Plan B One-Step is a brand name product, it is not covered under our Preventive Services benefit. The generic products listed above are covered under this benefit and have the same active ingredient as Plan B One-Step.
3 ORAL CONTRACEPTIVES (BIRTH CONTROL PILLS): Oral Contraceptive- Mini Pill/Progestin Oral Contraceptive-Combined Pill (cont.) Camila Azurette Deblitane Balziva Errin Bekyree Heather Blisovi FE Jencycla Briellyn Lyza Camrese Nora-BE Camrese Lo Norethindrone 0.35mg Caziant Norlyroc Cesia Sharobel Chateal Oral Contraceptive-Extended/Continuous Use Cryselle 28 Amethia Cyclafem 1/35 Amethia Lo Cyclafem 7/7/7 Ashlyna Cyred Camrese Dasetta 1/35 Camrese Lo Dasetta 7/7/7 Daysee Daysee Introvale Delyla Jolessa Desogestrel-ethinyl estradiol Levonorgestrel-ethinyl estradiol (91-day pack) Drospirenone-ethinyl estradiol Quasense Drospirenone-ethinyl estradiol-levomefolate Setlakin Elinest Oral Contraceptive-Combined Pill Emoquette Altavera Enpresse 28 Alyacen 1/35 Enskyce Alyacen 7/7/7 Estarylla Amethia Ethynodiol diacetate-ethinyl estradiol Amethia Lo Falmina Amethyst Gianvi Apri Gildagia Aranelle Gildess 1.5/30 Ashlyna Gildess 1/20 Aubra Gildess 24 Fe Aviane Gildess Fe 1.5/30
4 Oral Contraceptive-Combined Pill (cont.) Gildess Fe 1/20 Necon 1/35 Introvale Necon 1/50-28 Jolessa Necon 10/11-28 Juleber Necon 7/7/7 Junel 1.5/30 Nikki Junel 1/20 Norethindrone-ethinyl estra ferrous fumarate Junel Fe 1.5/30 Norethindrone ace-ethinyl estradiol Junel Fe 1/20 Norethindrone ace-ethinyl estradiol-fe Kariva Norethindrone-ethinyl estra ferrous fumarate Kelnor 1/35 Norethindrone ace-ethinyl estradiol Kimidess Norethindrone ace-ethinyl estradiol-fe Kurvelo Norgestimate-ethinyl estradiol Larin 1.5/30 Nortrel Larin 1/20 Ocella Larin 24 Fe Ogestrel Larin Fe 1.5/30 Orsythia Larin Fe 1/20 Philith Layolis Fe Philith Leena Pimtrea Lessina Pirmella 1/35 Levonest Pirmella 7/7/7 Levonorgestrel-ethinyl estradiol Portia 28 Levora 0.15/30-28 Previfem Lomedia 24 Fe Quasense Loryna Rajani Low-Ogestrel Reclipsen Lutera Solia Mibelas 24 Fe Sprintec 28 Microgestin 1.5/30 Sronyx Microgestin 1/20 Syeda Microgestin Fe Tarina Fe 1/20 Microgestin Fe 1.5/30 Tilia Fe Mono-Linyah Tri-Estarylla Mononessa Tri-Legest Fe Myzilra Tri-Linyah Necon 0.5/35-28 Tri-Lo-Estarylla
5 Oral Contraceptive-Combined Pill (cont.) Tri-Lo-Marzia Tri-Lo-Sprintec TriNessa TriNessa Lo Tri-Previfem Tri-Sprintec Trivora 28 Velivet Vestura Vienva Viorele Vyfemla Wera Wymzya Fe Zarah Zenchent Zenchent Fe Zovia 1/35E Zovia 1/50E
6 Contraceptives Available From a Doctor The following contraceptive products and sterilization services are available from an eligible medical provider and will be processed under your medical benefit. Please see your health plan s website or contact Customer Service for information on eligible medical providers. BARRIER METHODS: Diaphragm Cervical Cap NON-ORAL HORMONAL METHODS: Shot/Injection Medroxyprogesterone acetate 150 mg/ml IMPLANTED DEVICES: IUD Copper Paragard IUD with Progestin Kyleena, Liletta, Mirena, Skyla Implantable Rod Nexplanon OTHER: Surgical Implant Surgical Sterilization Questions? Call the Customer Service number on your member ID card.
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