Drugs for Women
Birth Control Pills

BRAND NAME: Altavera - generic.gif (400 bytes) Generic Available
Note: Brand name drugs are listed for reference only. The approval status and restrictions indicated below apply only to the brand's generic equivalent. Certain brand drugs may not be covered by your health plan. Please contact your health plan for additional information.

GENERIC NAME: 
levonorgestrel-ethinyl estrad
  Status Notes or Restrictions
Anthem Blue Cross (HMO, PPO, EPO) preferred.gif (540 bytes)  
Cigna + Oscar preferred.gif (540 bytes) NOTES.gif (377 bytes)
Health Net preferred.gif (540 bytes) NOTES.gif (377 bytes)
Kaiser Foundation Health Plan Northern California approved.gif (510 bytes)  
Kaiser Foundation Health Plan Southern California approved.gif (510 bytes)  
Oscar preferred.gif (540 bytes) NOTES.gif (377 bytes)
Sharp Health Plan preferred.gif (540 bytes)  
Sutter Health Plus preferred.gif (540 bytes)  
UnitedHealthcare preferred.gif (540 bytes) NOTES.gif (377 bytes)
Western Health Advantage preferred.gif (540 bytes)  


preferred.gif (540 bytes)  Preferred

approved.gif (510 bytes)   Approved

priorauth.gif (816 bytes)  Prior Auth.
nonform.gif (625 bytes)    Non-Formulary notreimb.gif (645 bytes)   Not Reimbursed notlisted.gif (324 bytes)   Not Listed
nonform.gif (625 bytes)    Benefits/Policies generic.gif (400 bytes) Generic Available, Brand Listed for reference only. Brand may not be covered.

NOTES.gif (377 bytes)NOTES_restrict.gif (372 bytes)

 Notes or
Restrictions

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