备注标题
非承保药物的例外情况
定义
您的医生可以提交例外请求。如果获得批准，该药物仍必须符合任何适用要求，然后才能被您的计划承保。您还将支付最高级别的费用。
药物查询
下列结果按2级计划排序。要获得最准确的搜索结果，请查看计划详情，从搜索栏附近的下拉菜单中选择其他分级计划。
TAYTULLA
THERAPEUTIC CLASS: Contraceptives**
选择强度来查看详细信息
1MG/20MCG片剂
事先授权表
重要信息
对于联邦雇员计划会员
符合资格的Medicare会员
承保的替代药物
- ALTAVERA (Eligible for $0 copay)
- APRI 28 (Eligible for $0 copay)
- AVIANE 28 (Eligible for $0 copay)
- AZURETTE 28 (Eligible for $0 copay)
- BRIELLYN (Eligible for $0 copay)
- CRYSELLE 28 (Eligible for $0 copay)
- EMOQUETTE 28 (Eligible for $0 copay)
- DASETTA 1/35 (Eligible for $0 copay)
- DASETTA 7/7/7 (Eligible for $0 copay)
- FALMINA (Eligible for $0 copay)
- GENERESS FE
- INTROVALE (Eligible for $0 copay)
- KELNOR 1/35 (Eligible for $0 copay)
- KELNOR 1/50 (Eligible for $0 copay)
- JUNEL 1.5/30 (Eligible for $0 copay)
- JUNEL 1/20 (Eligible for $0 copay)
- LESSINA (Eligible for $0 copay)
- LEVLITE -28
- LEVONEST (Eligible for $0 co-pay)
- LEVORA (Eligible for $0 copay)
- LOESTRIN -1/20 (Eligible for $0 copay)
- LOESTRIN -FE 1/20 (Eligible for $0 copay)
- LOESTRIN 1.5/30 (Eligible for $0 copay)
- LOESTRIN FE 1.5/30 (Eligible for $0 copay)
- LORYNA (Eligible for $0 copay)
- LOW-OGESTREL (Eligible for $0 copay)
- LO/OVRAL
- LUTERA (Eligible for $0 copay)
- MICROGESTIN 1.5/30 (Eligible for $0 copay)
- MARLISSA (Eligible for $0 copay)
- MICROGESTIN 1/20 (Eligible for $0 copay)
- MODICON 28 TABS
- MONO-LINYAH (Eligible for $0 co-pay)
- MONONESSA (Eligible for $0 copay)
- NECON .5/35 21 (Eligible for $0 copay)
- NECON .5/35 28 (Eligible for $0 copay)
- NECON 1/35 21 (Eligible for $0 copay)
- NECON 1/35 28 (Eligible for $0 copay)
- NECON 1/50 21 (Eligible for $0 copay)
- NECON 1/50 28 (Eligible for $0 copay)
- NORDETTE 21 TABS
- NORDETTE 28 TABS
- NORTREL (Eligible for $0 copay)
- ORTHO-CYCLEN 28
- OGESTREL (Eligible for $0 copay)
- ORTHO-CEPT 28 TABS
- ORTHO-EVRA (Eligible for $0 co-pay)
- ORTHO-NOVUM -1/35 28 TABS
- ORSYTHIA (Eligible for $0 copay)
- OVRAL -21
- OVRAL -28
- PHILITH (Eligible for $0 copay)
- PORTIA (Eligible for $0 copay)
- PREVIFEM (Eligible for $0 copay)
- RECLIPSEN (Eligible for $0 copay)
- SOLIA (Eligible for $0 copay)
- SPRINTEC (Eligible for $0 copay)
- SYEDA (Eligible for $0 copay)
- YASMIN 28
- VESTURA (Eligible for $0 copay)
- WERA 28 (Eligible or $0 co-pay)
- WYMZYA FE (Eligible for $0 co-pay)
- XULANE (Eligible for $0 co-pay)
- ZENCHENT (Eligible for $0 copay)
- ZENCHENT FE (Eligible for $0 copay)
- ZEOSA (Eligible for $0 copay)
- ZOVIA 1/35E (Eligible for $0 copay)
- ZOVIA 1/50E (Eligible for $0 copay)