Home Health iDBL
Interactive Drug Benefit List
DIN/NPN/ PIN Generic Name Product Name, Strength & Dosage Form Unit Price, Unit of Issue Manufacturer LCA Price MAC Price Interchangeable Products Coverage Status
02317192 DESOGESTREL/ ETHINYL ESTRADIOL APRI 21 0.15 MG * 0.03 MG ORAL TABLET 0.3700
TAB 		TEV 0.3700 N/A YES REGULAR BENEFIT Details
02317206 DESOGESTREL/ ETHINYL ESTRADIOL APRI 28 0.15 MG * 0.03 MG ORAL TABLET 0.2775
TAB 		TEV 0.2775 N/A YES REGULAR BENEFIT Details
02396491 DESOGESTREL/ ETHINYL ESTRADIOL FREYA 21 0.15 MG * 0.03 MG ORAL TABLET 0.3700
TAB 		MYP 0.3700 N/A YES REGULAR BENEFIT Details
02396610 DESOGESTREL/ ETHINYL ESTRADIOL FREYA 28 0.15 MG * 0.03 MG ORAL TABLET 0.2775
TAB 		MYP 0.2775 N/A YES REGULAR BENEFIT Details
02042487 DESOGESTREL/ ETHINYL ESTRADIOL MARVELON (21 DAY) 0.15 MG * 0.03 MG ORAL TABLET 0.7289
TAB 		ORC 0.3700 N/A YES REGULAR BENEFIT Details
02042479 DESOGESTREL/ ETHINYL ESTRADIOL MARVELON (28 DAY) 0.15 MG * 0.03 MG ORAL TABLET 0.5467
TAB 		ORC 0.2775 N/A YES REGULAR BENEFIT Details
02410249 DESOGESTREL/ ETHINYL ESTRADIOL MIRVALA 21 0.15 MG * 0.03 MG ORAL TABLET 0.3700
TAB 		APX 0.3700 N/A YES REGULAR BENEFIT Details
02410257 DESOGESTREL/ ETHINYL ESTRADIOL MIRVALA 28 0.15 MG * 0.03 MG ORAL TABLET 0.2775
TAB 		APX 0.2775 N/A YES REGULAR BENEFIT Details
02272903 DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL LINESSA 21 0.1 MG * 0.025 MG * 0.125 MG * 0.025 MG * 0.15 MG * 0.025 MG ORAL TABLET 0.8559
TAB 		APC N/A N/A NO REGULAR BENEFIT Details
02257238 DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL LINESSA 28 0.1 MG * 0.025 MG * 0.125 MG * 0.025 MG * 0.15 MG * 0.025 MG ORAL TABLET 0.6419
TAB 		APC N/A N/A NO REGULAR BENEFIT Details
02321157 DROSPIRENONE/ ETHINYL ESTRADIOL YAZ 28 3 MG * 0.02 MG ORAL TABLET N/A
TAB 		BAI N/A N/A NO NOT A BENEFIT Details
02421437 DROSPIRENONE/ ETHINYL ESTRADIOL DROSPIRENONE AND ETHINYL ESTRADIOL 3 MG * 0.03 MG ORAL TABLET 0.2962
TAB 		GLM 0.2962 N/A YES REGULAR BENEFIT Details
02421445 DROSPIRENONE/ ETHINYL ESTRADIOL DROSPIRENONE AND ETHINYL ESTRADIOL 3 MG * 0.03 MG ORAL TABLET 0.2221
TAB 		GLM 0.2221 N/A YES REGULAR BENEFIT Details
02261723 DROSPIRENONE/ ETHINYL ESTRADIOL YASMIN 21 3 MG * 0.03 MG ORAL TABLET 0.5924
TAB 		BAI 0.2962 N/A YES REGULAR BENEFIT Details
02261731 DROSPIRENONE/ ETHINYL ESTRADIOL YASMIN 28 3 MG * 0.03 MG ORAL TABLET 0.4443
TAB 		BAI 0.2221 N/A YES REGULAR BENEFIT Details
02410788 DROSPIRENONE/ ETHINYL ESTRADIOL ZAMINE 21 3 MG * 0.03 MG ORAL TABLET 0.2962
TAB 		APX 0.2962 N/A YES REGULAR BENEFIT Details
02410796 DROSPIRENONE/ ETHINYL ESTRADIOL ZAMINE 28 3 MG * 0.03 MG ORAL TABLET 0.2221
TAB 		APX 0.2221 N/A YES REGULAR BENEFIT Details
02238704 ESTRADIOL-17B ESTROGEL 0.06 % TRANSDERMAL GEL 0.3710
G 		ORC N/A N/A NO REGULAR BENEFIT Details
02424924 ESTRADIOL-17B DIVIGEL (0.25 MG PACK) 0.1 % TRANSDERMAL GEL 0.8696
PCKT 		SLP N/A N/A NO REGULAR BENEFIT Details
02424835 ESTRADIOL-17B DIVIGEL (0.5 MG PACK) 0.1 % TRANSDERMAL GEL 0.8696
PCKT 		SLP N/A N/A NO REGULAR BENEFIT Details
02424843 ESTRADIOL-17B DIVIGEL (1 MG PACK) 0.1 % TRANSDERMAL GEL 0.8696
PCKT 		SLP N/A N/A NO REGULAR BENEFIT Details
02449048 ESTRADIOL-17B LUPIN-ESTRADIOL 0.5 MG ORAL TABLET 0.1199
TAB 		LPC 0.1199 N/A NO REGULAR BENEFIT Details
02449056 ESTRADIOL-17B LUPIN-ESTRADIOL 1 MG ORAL TABLET 0.2313
TAB 		LPC 0.2313 N/A NO REGULAR BENEFIT Details
02503697 ESTRADIOL-17B IMVEXXY 10 MCG VAGINAL INSERT 3.6288
CAP 		KTI N/A N/A NO REGULAR BENEFIT Details
02325462 ESTRADIOL-17B VAGIFEM 10 MCG VAGINAL TABLET 4.6933
TAB 		NNA N/A N/A NO REGULAR BENEFIT Details
02244002 ESTRADIOL-17B ESTRADOT 100 (1.56 MG/PTH) 100 MCG/DAY TRANSDERMAL PATCH 3.7525
PTH 		SDZ 3.3175 N/A YES REGULAR BENEFIT Details
02246969 ESTRADIOL-17B SANDOZ ESTRADIOL DERM 100 (8 MG/PTH) 100 MCG/DAY TRANSDERMAL PATCH 3.3175
PTH 		SDZ 3.3175 N/A YES REGULAR BENEFIT Details
02168898 ESTRADIOL-17B ESTRING 2 MG VAGINAL SLOW-RELEASE RING 79.7844
RING 		PAL N/A N/A NO REGULAR BENEFIT Details
02449064 ESTRADIOL-17B LUPIN-ESTRADIOL 2 MG ORAL TABLET 0.4083
TAB 		LPC 0.4083 N/A NO REGULAR BENEFIT Details
02247499 ESTRADIOL-17B CLIMARA 25 (2 MG/PTH) 25 MCG/DAY TRANSDERMAL PATCH 5.1600
PTH 		BAI N/A N/A NO REGULAR BENEFIT Details
02245676 ESTRADIOL-17B ESTRADOT 25 (0.39 MG/PTH) 25 MCG/DAY TRANSDERMAL PATCH 3.0850
PTH 		SDZ N/A N/A NO REGULAR BENEFIT Details
02243722 ESTRADIOL-17B OESCLIM 25 (5 MG/PTH) 25 MCG/DAY TRANSDERMAL PATCH 3.0219
PTH 		SLP N/A N/A NO REGULAR BENEFIT Details
02243999 ESTRADIOL-17B ESTRADOT 37.5 (0.585 MG/PTH) 37.5 MCG/DAY TRANSDERMAL PATCH 3.1050
PTH 		SDZ N/A N/A NO REGULAR BENEFIT Details
02503689 ESTRADIOL-17B IMVEXXY 4 MCG VAGINAL INSERT 3.6288
CAP 		KTI N/A N/A NO REGULAR BENEFIT Details
02231509 ESTRADIOL-17B CLIMARA 50 (3.9 MG/PTH) 50 MCG/DAY TRANSDERMAL PATCH 5.5118
PTH 		BAI 2.6598 N/A NO REGULAR BENEFIT Details
02244000 ESTRADIOL-17B ESTRADOT 50 (0.78 MG/PTH) 50 MCG/DAY TRANSDERMAL PATCH 3.3125
PTH 		SDZ 2.6598 N/A YES REGULAR BENEFIT Details
02243724 ESTRADIOL-17B OESCLIM 50 (10 MG/PTH) 50 MCG/DAY TRANSDERMAL PATCH 3.0349
PTH 		SLP 2.6598 N/A NO REGULAR BENEFIT Details
02246967 ESTRADIOL-17B SANDOZ ESTRADIOL DERM 50 (4 MG/PTH) 50 MCG/DAY TRANSDERMAL PATCH 2.6598
PTH 		SDZ 2.6598 N/A YES REGULAR BENEFIT Details
02247500 ESTRADIOL-17B CLIMARA 75 (5.7 MG/PTH) 75 MCG/DAY TRANSDERMAL PATCH 5.8764
PTH 		BAI 3.2900 N/A NO REGULAR BENEFIT Details
02244001 ESTRADIOL-17B ESTRADOT 75 (1.17 MG/PTH) 75 MCG/DAY TRANSDERMAL PATCH 3.5500
PTH 		SDZ 3.2900 N/A YES REGULAR BENEFIT Details
02246968 ESTRADIOL-17B SANDOZ ESTRADIOL DERM 75 (6 MG/PTH) 75 MCG/DAY TRANSDERMAL PATCH 3.2900
PTH 		SDZ 3.2900 N/A YES REGULAR BENEFIT Details
02505223 ESTRADIOL-17B/ PROGESTERONE BIJUVA 1 MG * 100 MG ORAL CAPSULE 0.8962
CAP 		KTI N/A N/A NO REGULAR BENEFIT Details
02253186 ETONOGESTREL/ ETHINYL ESTRADIOL NUVARING 120 MCG/DAY * 15 MCG/DAY VAGINAL SLOW-RELEASE RING N/A
RING 		ORC N/A N/A NO NOT A BENEFIT Details
02236974 LEVONORGESTREL/ ETHINYL ESTRADIOL ALESSE (21 DAY) 100 MCG * 20 MCG ORAL TABLET 0.7470
TAB 		PFI 0.1877 N/A YES REGULAR BENEFIT Details
02236975 LEVONORGESTREL/ ETHINYL ESTRADIOL ALESSE (28 DAY) 100 MCG * 20 MCG ORAL TABLET 0.5604
TAB 		PFI 0.1408 N/A YES REGULAR BENEFIT Details
02387875 LEVONORGESTREL/ ETHINYL ESTRADIOL ALYSENA 21 100 MCG * 20 MCG ORAL TABLET 0.1877
TAB 		APX 0.1877 N/A YES REGULAR BENEFIT Details
02387883 LEVONORGESTREL/ ETHINYL ESTRADIOL ALYSENA 28 100 MCG * 20 MCG ORAL TABLET 0.1408
TAB 		APX 0.1408 N/A YES REGULAR BENEFIT Details
02532174 LEVONORGESTREL/ ETHINYL ESTRADIOL AUDRINA (21 DAY) 100 MCG * 20 MCG ORAL TABLET 0.1877
TAB 		JPC 0.1877 N/A YES REGULAR BENEFIT Details
02532182 LEVONORGESTREL/ ETHINYL ESTRADIOL AUDRINA (28 DAY) 100 MCG * 20 MCG ORAL TABLET 0.1408
TAB 		JPC 0.1408 N/A YES REGULAR BENEFIT Details
02298538 LEVONORGESTREL/ ETHINYL ESTRADIOL AVIANE 21 100 MCG * 20 MCG ORAL TABLET 0.1877
TAB 		TEV 0.1877 N/A YES REGULAR BENEFIT Details
02298546 LEVONORGESTREL/ ETHINYL ESTRADIOL AVIANE 28 100 MCG * 20 MCG ORAL TABLET 0.1408
TAB 		TEV 0.1408 N/A YES REGULAR BENEFIT Details
02387085 LEVONORGESTREL/ ETHINYL ESTRADIOL OVIMA 21 150 MCG * 30 MCG ORAL TABLET 0.3467
TAB 		APX 0.3467 N/A YES REGULAR BENEFIT Details
02387093 LEVONORGESTREL/ ETHINYL ESTRADIOL OVIMA 28 150 MCG * 30 MCG ORAL TABLET 0.2600
TAB 		APX 0.2600 N/A YES REGULAR BENEFIT Details
02295946 LEVONORGESTREL/ ETHINYL ESTRADIOL PORTIA 21 150 MCG * 30 MCG ORAL TABLET 0.3467
TAB 		TEV 0.3467 N/A YES REGULAR BENEFIT Details
02295954 LEVONORGESTREL/ ETHINYL ESTRADIOL PORTIA 28 150 MCG * 30 MCG ORAL TABLET 0.2600
TAB 		TEV 0.2600 N/A YES REGULAR BENEFIT Details
00707600 LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL TRIQUILAR (21 DAY) 50 MCG * 30 MCG * 75 MCG * 40 MCG * 125 MCG * 30 MCG ORAL TABLET 0.7500
TAB 		BAI N/A N/A NO REGULAR BENEFIT Details
00707503 LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL TRIQUILAR (28 DAY) 50 MCG * 30 MCG * 75 MCG * 40 MCG * 125 MCG * 30 MCG ORAL TABLET 0.5625
TAB 		BAI N/A N/A NO REGULAR BENEFIT Details
02248297 NORELGESTROMIN/ ETHINYL ESTRADIOL EVRA (6MG*0.6MG/PTH) 150 MCG/DAY * 20 MCG/DAY TRANSDERMAL PATCH N/A
PTH 		JAI N/A N/A NO NOT A BENEFIT Details
02241835 NORETHINDRONE ACETATE/ ESTRADIOL-17B ESTALIS 140/50 140 MCG/DAY * 50 MCG/DAY TRANSDERMAL PATCH 3.6725
PTH 		SDZ N/A N/A NO REGULAR BENEFIT Details
02241837 NORETHINDRONE ACETATE/ ESTRADIOL-17B ESTALIS 250/50 250 MCG/DAY * 50 MCG/DAY TRANSDERMAL PATCH 3.6725
PTH 		SDZ N/A N/A NO REGULAR BENEFIT Details
02417456 NORETHINDRONE ACETATE/ ETHINYL ESTRADIOL/ ETHINYL ESTRADIOL LOLO 1 MG * 10 MCG * 10 MCG ORAL TABLET N/A
TAB 		ABV N/A N/A NO NOT A BENEFIT Details
02187108 NORETHINDRONE/ ETHINYL ESTRADIOL/ NORETHINDRONE/ ETHINYL ESTRADIOL SYNPHASIC (21 DAY) 0.5 MG * 0.035 MG * 1 MG * 0.035 MG ORAL TABLET 0.6494
TAB 		PFI N/A N/A NO REGULAR BENEFIT Details
02187116 NORETHINDRONE/ ETHINYL ESTRADIOL/ NORETHINDRONE/ ETHINYL ESTRADIOL SYNPHASIC (28 DAY) 0.5 MG * 0.035 MG * 1 MG * 0.035 MG ORAL TABLET 0.4870
TAB 		PFI N/A N/A NO REGULAR BENEFIT Details
02401967 NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL TRICIRA LO 21 0.18 MG * 0.025 MG * 0.215 MG * 0.025 MG * 0.25 MG * 0.025 MG ORAL TABLET 0.7877
TAB 		APX N/A N/A NO REGULAR BENEFIT Details
02401975 NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL TRICIRA LO 28 0.18 MG * 0.025 MG * 0.215 MG * 0.025 MG * 0.25 MG * 0.025 MG ORAL TABLET 0.5908
TAB 		APX N/A N/A NO REGULAR BENEFIT Details
02508087 NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL TRI-CIRA 21 0.18 MG * 0.035 MG * 0.215 MG * 0.035 MG * 0.25 MG * 0.035 MG ORAL TABLET 0.6852
TAB 		APX 0.6852 N/A YES REGULAR BENEFIT Details
02508095 NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL TRI-CIRA 28 0.18 MG * 0.035 MG * 0.215 MG * 0.035 MG * 0.25 MG * 0.035 MG ORAL TABLET 0.5139
TAB 		APX 0.5139 N/A YES REGULAR BENEFIT Details
02486296 NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL TRI-JORDYNA (21 DAY) 0.18 MG * 0.035 MG * 0.215 MG * 0.035 MG * 0.25 MG * 0.035 MG ORAL TABLET 0.6852
TAB 		GLM 0.6852 N/A YES REGULAR BENEFIT Details
02486318 NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL TRI-JORDYNA 28 (28 DAY) 0.18 MG * 0.035 MG * 0.215 MG * 0.035 MG * 0.25 MG * 0.035 MG ORAL TABLET 0.5139
TAB 		GLM 0.5139 N/A YES REGULAR BENEFIT Details
DIN/NPN/ PIN 02317192
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form APRI 21 0.15 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.3700
Manufacturer TEV
LCA Price 0.3700
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02317206
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form APRI 28 0.15 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.2775
Manufacturer TEV
LCA Price 0.2775
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02396491
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form FREYA 21 0.15 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.3700
Manufacturer MYP
LCA Price 0.3700
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02396610
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form FREYA 28 0.15 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.2775
Manufacturer MYP
LCA Price 0.2775
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02042487
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form MARVELON (21 DAY) 0.15 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.7289
Manufacturer ORC
LCA Price 0.3700
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02042479
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form MARVELON (28 DAY) 0.15 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.5467
Manufacturer ORC
LCA Price 0.2775
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02410249
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form MIRVALA 21 0.15 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.3700
Manufacturer APX
LCA Price 0.3700
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02410257
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form MIRVALA 28 0.15 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.2775
Manufacturer APX
LCA Price 0.2775
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02272903
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form LINESSA 21 0.1 MG * 0.025 MG * 0.125 MG * 0.025 MG * 0.15 MG * 0.025 MG ORAL TABLET
Unit Price, Unit of Issue 0.8559
Manufacturer APC
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02257238
Generic Name DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form LINESSA 28 0.1 MG * 0.025 MG * 0.125 MG * 0.025 MG * 0.15 MG * 0.025 MG ORAL TABLET
Unit Price, Unit of Issue 0.6419
Manufacturer APC
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02321157
Generic Name DROSPIRENONE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form YAZ 28 3 MG * 0.02 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer BAI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02421437
Generic Name DROSPIRENONE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form DROSPIRENONE AND ETHINYL ESTRADIOL 3 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.2962
Manufacturer GLM
LCA Price 0.2962
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02421445
Generic Name DROSPIRENONE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form DROSPIRENONE AND ETHINYL ESTRADIOL 3 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.2221
Manufacturer GLM
LCA Price 0.2221
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02261723
Generic Name DROSPIRENONE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form YASMIN 21 3 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.5924
Manufacturer BAI
LCA Price 0.2962
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02261731
Generic Name DROSPIRENONE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form YASMIN 28 3 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.4443
Manufacturer BAI
LCA Price 0.2221
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02410788
Generic Name DROSPIRENONE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form ZAMINE 21 3 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.2962
Manufacturer APX
LCA Price 0.2962
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02410796
Generic Name DROSPIRENONE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form ZAMINE 28 3 MG * 0.03 MG ORAL TABLET
Unit Price, Unit of Issue 0.2221
Manufacturer APX
LCA Price 0.2221
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02238704
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form ESTROGEL 0.06 % TRANSDERMAL GEL
Unit Price, Unit of Issue 0.3710
Manufacturer ORC
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02424924
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form DIVIGEL (0.25 MG PACK) 0.1 % TRANSDERMAL GEL
Unit Price, Unit of Issue 0.8696
Manufacturer SLP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02424835
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form DIVIGEL (0.5 MG PACK) 0.1 % TRANSDERMAL GEL
Unit Price, Unit of Issue 0.8696
Manufacturer SLP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02424843
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form DIVIGEL (1 MG PACK) 0.1 % TRANSDERMAL GEL
Unit Price, Unit of Issue 0.8696
Manufacturer SLP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02449048
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form LUPIN-ESTRADIOL 0.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.1199
Manufacturer LPC
LCA Price 0.1199
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02449056
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form LUPIN-ESTRADIOL 1 MG ORAL TABLET
Unit Price, Unit of Issue 0.2313
Manufacturer LPC
LCA Price 0.2313
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02503697
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form IMVEXXY 10 MCG VAGINAL INSERT
Unit Price, Unit of Issue 3.6288
Manufacturer KTI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02325462
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form VAGIFEM 10 MCG VAGINAL TABLET
Unit Price, Unit of Issue 4.6933
Manufacturer NNA
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02244002
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form ESTRADOT 100 (1.56 MG/PTH) 100 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.7525
Manufacturer SDZ
LCA Price 3.3175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02246969
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form SANDOZ ESTRADIOL DERM 100 (8 MG/PTH) 100 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.3175
Manufacturer SDZ
LCA Price 3.3175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02168898
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form ESTRING 2 MG VAGINAL SLOW-RELEASE RING
Unit Price, Unit of Issue 79.7844
Manufacturer PAL
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02449064
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form LUPIN-ESTRADIOL 2 MG ORAL TABLET
Unit Price, Unit of Issue 0.4083
Manufacturer LPC
LCA Price 0.4083
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02247499
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form CLIMARA 25 (2 MG/PTH) 25 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 5.1600
Manufacturer BAI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02245676
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form ESTRADOT 25 (0.39 MG/PTH) 25 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.0850
Manufacturer SDZ
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02243722
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form OESCLIM 25 (5 MG/PTH) 25 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.0219
Manufacturer SLP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02243999
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form ESTRADOT 37.5 (0.585 MG/PTH) 37.5 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.1050
Manufacturer SDZ
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02503689
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form IMVEXXY 4 MCG VAGINAL INSERT
Unit Price, Unit of Issue 3.6288
Manufacturer KTI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02231509
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form CLIMARA 50 (3.9 MG/PTH) 50 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 5.5118
Manufacturer BAI
LCA Price 2.6598
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02244000
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form ESTRADOT 50 (0.78 MG/PTH) 50 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.3125
Manufacturer SDZ
LCA Price 2.6598
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02243724
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form OESCLIM 50 (10 MG/PTH) 50 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.0349
Manufacturer SLP
LCA Price 2.6598
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02246967
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form SANDOZ ESTRADIOL DERM 50 (4 MG/PTH) 50 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 2.6598
Manufacturer SDZ
LCA Price 2.6598
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02247500
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form CLIMARA 75 (5.7 MG/PTH) 75 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 5.8764
Manufacturer BAI
LCA Price 3.2900
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02244001
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form ESTRADOT 75 (1.17 MG/PTH) 75 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.5500
Manufacturer SDZ
LCA Price 3.2900
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02246968
Generic Name ESTRADIOL-17B
Product Name, Strength & Dosage Form SANDOZ ESTRADIOL DERM 75 (6 MG/PTH) 75 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.2900
Manufacturer SDZ
LCA Price 3.2900
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02505223
Generic Name ESTRADIOL-17B/ PROGESTERONE
Product Name, Strength & Dosage Form BIJUVA 1 MG * 100 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.8962
Manufacturer KTI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02253186
Generic Name ETONOGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form NUVARING 120 MCG/DAY * 15 MCG/DAY VAGINAL SLOW-RELEASE RING
Unit Price, Unit of Issue N/A
Manufacturer ORC
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02236974
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form ALESSE (21 DAY) 100 MCG * 20 MCG ORAL TABLET
Unit Price, Unit of Issue 0.7470
Manufacturer PFI
LCA Price 0.1877
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02236975
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form ALESSE (28 DAY) 100 MCG * 20 MCG ORAL TABLET
Unit Price, Unit of Issue 0.5604
Manufacturer PFI
LCA Price 0.1408
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02387875
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form ALYSENA 21 100 MCG * 20 MCG ORAL TABLET
Unit Price, Unit of Issue 0.1877
Manufacturer APX
LCA Price 0.1877
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02387883
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form ALYSENA 28 100 MCG * 20 MCG ORAL TABLET
Unit Price, Unit of Issue 0.1408
Manufacturer APX
LCA Price 0.1408
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02532174
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form AUDRINA (21 DAY) 100 MCG * 20 MCG ORAL TABLET
Unit Price, Unit of Issue 0.1877
Manufacturer JPC
LCA Price 0.1877
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02532182
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form AUDRINA (28 DAY) 100 MCG * 20 MCG ORAL TABLET
Unit Price, Unit of Issue 0.1408
Manufacturer JPC
LCA Price 0.1408
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02298538
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form AVIANE 21 100 MCG * 20 MCG ORAL TABLET
Unit Price, Unit of Issue 0.1877
Manufacturer TEV
LCA Price 0.1877
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02298546
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form AVIANE 28 100 MCG * 20 MCG ORAL TABLET
Unit Price, Unit of Issue 0.1408
Manufacturer TEV
LCA Price 0.1408
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02387085
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form OVIMA 21 150 MCG * 30 MCG ORAL TABLET
Unit Price, Unit of Issue 0.3467
Manufacturer APX
LCA Price 0.3467
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02387093
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form OVIMA 28 150 MCG * 30 MCG ORAL TABLET
Unit Price, Unit of Issue 0.2600
Manufacturer APX
LCA Price 0.2600
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02295946
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form PORTIA 21 150 MCG * 30 MCG ORAL TABLET
Unit Price, Unit of Issue 0.3467
Manufacturer TEV
LCA Price 0.3467
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02295954
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form PORTIA 28 150 MCG * 30 MCG ORAL TABLET
Unit Price, Unit of Issue 0.2600
Manufacturer TEV
LCA Price 0.2600
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00707600
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form TRIQUILAR (21 DAY) 50 MCG * 30 MCG * 75 MCG * 40 MCG * 125 MCG * 30 MCG ORAL TABLET
Unit Price, Unit of Issue 0.7500
Manufacturer BAI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00707503
Generic Name LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form TRIQUILAR (28 DAY) 50 MCG * 30 MCG * 75 MCG * 40 MCG * 125 MCG * 30 MCG ORAL TABLET
Unit Price, Unit of Issue 0.5625
Manufacturer BAI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02248297
Generic Name NORELGESTROMIN/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form EVRA (6MG*0.6MG/PTH) 150 MCG/DAY * 20 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue N/A
Manufacturer JAI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02241835
Generic Name NORETHINDRONE ACETATE/ ESTRADIOL-17B
Product Name, Strength & Dosage Form ESTALIS 140/50 140 MCG/DAY * 50 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.6725
Manufacturer SDZ
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02241837
Generic Name NORETHINDRONE ACETATE/ ESTRADIOL-17B
Product Name, Strength & Dosage Form ESTALIS 250/50 250 MCG/DAY * 50 MCG/DAY TRANSDERMAL PATCH
Unit Price, Unit of Issue 3.6725
Manufacturer SDZ
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02417456
Generic Name NORETHINDRONE ACETATE/ ETHINYL ESTRADIOL/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form LOLO 1 MG * 10 MCG * 10 MCG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer ABV
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02187108
Generic Name NORETHINDRONE/ ETHINYL ESTRADIOL/ NORETHINDRONE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form SYNPHASIC (21 DAY) 0.5 MG * 0.035 MG * 1 MG * 0.035 MG ORAL TABLET
Unit Price, Unit of Issue 0.6494
Manufacturer PFI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02187116
Generic Name NORETHINDRONE/ ETHINYL ESTRADIOL/ NORETHINDRONE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form SYNPHASIC (28 DAY) 0.5 MG * 0.035 MG * 1 MG * 0.035 MG ORAL TABLET
Unit Price, Unit of Issue 0.4870
Manufacturer PFI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02401967
Generic Name NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form TRICIRA LO 21 0.18 MG * 0.025 MG * 0.215 MG * 0.025 MG * 0.25 MG * 0.025 MG ORAL TABLET
Unit Price, Unit of Issue 0.7877
Manufacturer APX
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02401975
Generic Name NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form TRICIRA LO 28 0.18 MG * 0.025 MG * 0.215 MG * 0.025 MG * 0.25 MG * 0.025 MG ORAL TABLET
Unit Price, Unit of Issue 0.5908
Manufacturer APX
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02508087
Generic Name NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form TRI-CIRA 21 0.18 MG * 0.035 MG * 0.215 MG * 0.035 MG * 0.25 MG * 0.035 MG ORAL TABLET
Unit Price, Unit of Issue 0.6852
Manufacturer APX
LCA Price 0.6852
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02508095
Generic Name NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form TRI-CIRA 28 0.18 MG * 0.035 MG * 0.215 MG * 0.035 MG * 0.25 MG * 0.035 MG ORAL TABLET
Unit Price, Unit of Issue 0.5139
Manufacturer APX
LCA Price 0.5139
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02486296
Generic Name NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form TRI-JORDYNA (21 DAY) 0.18 MG * 0.035 MG * 0.215 MG * 0.035 MG * 0.25 MG * 0.035 MG ORAL TABLET
Unit Price, Unit of Issue 0.6852
Manufacturer GLM
LCA Price 0.6852
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02486318
Generic Name NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL
Product Name, Strength & Dosage Form TRI-JORDYNA 28 (28 DAY) 0.18 MG * 0.035 MG * 0.215 MG * 0.035 MG * 0.25 MG * 0.035 MG ORAL TABLET
Unit Price, Unit of Issue 0.5139
Manufacturer GLM
LCA Price 0.5139
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
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Last Updated: 2024-05-18
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The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.