2015 Women`s Contraceptive Drug List

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2015 Women’s Contraceptive
Drugs and Devices List
www.aetna.com
05.03.400.1 I (1/15)
Nongrandfathered plans effective or renewing on or after
August 1, 2012, and subject to the Affordable Care Act,
also known as the health care reform law, will comply with
requirements for Women’s Preventive Health Services. This
means that for women with reproductive capacity, certain
women’s contraceptive drugs and devices approved by the
U.S. Food and Drug Administration (FDA) are covered at no
member cost share.
Certain religious organizations or religious employers
may be exempt from offering contraceptive services. If
these requirements apply to your plan, consult your plan
documents for more information.
The following list of contraceptive drugs and devices are
available with no member cost share when prescribed by
a doctor and obtained through Aetna’s network. Quantity
limits may also apply.
Category
Generic medicine
Brand-name medicine
Emergency
contraception
levonorgestrel tab 0.75mg
levonorgestrel tab 1.5 mg
my way tab
next choice tab
take action tab
none
Implanted devices
none
IMPLANON implantable rod
MIRENA intrauterine device
NEXPLANON implantable rod
PARAGARD intrauterine device
SKYLA intrauterine device
Injectables
medroxyprogesterone acetate injection
none
Taken by mouth
altavera tab
alyacen tab
amethia lo tab
amethia tab
amethyst tab
apri tab
aranelle tab
aubra tab
aviane tab
azurette tab
balziva tab
briellyn tab
camila tab
camrese lo tab
camrese tab
caziant pak
cesia pak
chateal tab
cryselle tab
cyclafem tab
dasetta tab
daysee tab
deblitane tab
delyla tab
desogestrel-ethinyl
estradiol tab
drospirenone/ethinyl
estradiol tab
elinest tab
emoquette tab
enpresse tab
enskyce tab
errin tab
estarylla tab
falmina tab
gianvi tab
gildagia tab
gildess tab
gildess fe tab
heather tab
introvale tab
jencycla tab
jolessa tab
jolivette tab
junel tab
junel fe tab
kariva tab
kelnor tab
kurvelo tab
larin tab
larin fe tab
leena tab
none
Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., Aetna
Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna).
In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington
Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products.
Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC.
Category
Generic medicine
Brand-name medicine
Taken by mouth
(continued)
lessina tab
levonest tab
levonorgestrel/ethinyl
estradiol tab
levora tab
loryna tab
low-ogestrel tab
lutera tab
lyza tab
marlissa tab
microgestin tab
microgestin tab fe
mononessa tab
mono-linyah tab
myzilra tab
necon tab
nikki tab
nora-be tab
norethindron tab
norgestimate/ethinyl
estradiol tab
norlyroc tab
nortrel tab
ocella tab
ogestrel tab
orsythia tab
philith tab
pimtrea tab
Vaginal barrier
none
CONCEPTROL spermicide
ENCARE spermicide
FC female condom
FC2 female condom
FEMCAP cervical cap
GYNOL spermicide
OMNIFLEX diaphragm
ORTHO-COIL diaphragm
ORTHO-FLAT diaphragm
ORTHO-FLEX diaphragm
PRENTIF cervical cap
SHUR-SEAL spermicide
TODAY sponge
VCF spermicide
WIDESEAL diaphragm
Vaginal ring
none
NUVARING
pirmella tab
portia tab
previfem tab
quasense tab
reclipsen tab
sharobel tab
solia tab
sprintec tab
sronyx tab
syeda tab
tilia fe tab
tri-estarylla tab
tri-legest fe tab
tri-linyah tab
trinessa tab
tri-previfem tab
tri-sprintec tab
trivora tab
velivet pak
vestura tab
viorele tab
vyfemla tab
wera tab
wymzya fe chw
zarah tab
zenchent fe chw
zenchent tab
zovia tab
none
This document may not be used after December 31, 2015.
This list only represents the drugs that fall under women’s preventive health services. It’s not a complete list of medications covered
under your plan. To check coverage and copay information for a specific medicine, visit www.aetna.com and log in to your secure
member website. For more details, please call the toll-free number on your member ID card.
Aetna may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. Your privacy
is important to us. Our employees are trained regarding the appropriate way to handle your private health information. Information
is believed to be accurate as of the production date; however, it is subject to change. For questions, please call the toll-free number
on your member ID card.
www.aetna.com
©2015 Aetna Inc.
05.03.400.1 I (1/15)