Uterine Fibroid Agents
| DRUG |
COVERED |
NOT COVERED |
| Oriahnn |
$5 |
|
| Myfembree |
$5 |
|
| Lupron Depot |
$10 |
|
| Orilissa |
$5 |
|
Menopause Agents
| DRUG |
COVERED |
NOT COVERED |
| Imvexxy |
$35 |
$75 |
| Duavee |
$25 |
|
| Osphena (30 tabs) |
$35 |
$99 |
| Combipatch |
$25 |
|
| Climara |
$25 |
|
| Bijuva |
$35 |
$75 |
Contraceptive Agents
| DRUG |
COVERED |
NOT COVERED |
| Nextstellis |
$0 |
$25 |
| Slynd |
$25 |
|
| Phexxi |
$0 first
$25 refills |
|
Nausea/Vomiting During Pregnancy
| DRUG |
COVERED |
NOT COVERED |
| Bonjesta |
$40 |
$160 |
| Diclegis (g) (60tabs) |
$60 |
|
Miscellaneous Agents
| Nitrofurantoin Sol |
25MG/5ML 230ML |
| Pre-nate Mini |
|
July 2025