Annovera

Generic: 273 DAY ethinyl estradiol

0.000542 MG/HR — Miscellaneous

CONTRACEPTIVES

Also known as: ANNOVERA MIS 273 DAY ethinyl estradiol

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 17 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Complete Gold with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive None
Standard Silver Tier 0 - $0 Preventive None
Standard Gold Tier 0 - $0 Preventive None
Everyday Bronze with Atrium Health Tier 0 - $0 Preventive None
Standard Gold with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive None
Standard Expanded Bronze Tier 0 - $0 Preventive None
Clear Silver with $0 Insulin Options Tier 0 - $0 Preventive None
Elite Bronze Tier 0 - $0 Preventive None
Everyday Bronze Tier 0 - $0 Preventive None
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 0 - $0 Preventive None
Complete Gold Tier 0 - $0 Preventive None
Standard Silver with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive None
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive None
Standard Gold + Vision + Adult Dental Tier 0 - $0 Preventive None
Standard Silver + Vision + Adult Dental Tier 0 - $0 Preventive None
Standard Expanded Bronze + Vision + Adult Dental Tier 0 - $0 Preventive None
Elite Bronze with Atrium Health Tier 0 - $0 Preventive None
Focused Silver with Atrium Health Tier 0 - $0 Preventive None
Complete Gold with Atrium Health Tier 0 - $0 Preventive None
Standard Expanded Bronze with Atrium Health Tier 0 - $0 Preventive None
Standard Silver with Atrium Health Tier 0 - $0 Preventive None
Standard Gold with Atrium Health Tier 0 - $0 Preventive None
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 0 - $0 Preventive None
Complete Gold + Vision + Adult Dental Tier 0 - $0 Preventive None
Everyday Bronze + Vision + Adult Dental Tier 0 - $0 Preventive None
Elite Bronze + Vision + Adult Dental Tier 0 - $0 Preventive None
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive None
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive None
Focused Silver with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Standard Option 2026 Tier 2 - Preferred Brand NCTM None
BCBS Federal Basic Option 2026 Tier 2 - Preferred Brand NCTM None
BCBS Federal Focus 2026 Tier 2 - Preferred Brand NCTM None
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 4 - Higher Cost Brand QL
BCBSNC Blue Care 2026 Tier 4 - Higher Cost Brand QL
BCBSNC Blue Local 2026 Tier 4 - Higher Cost Brand QL
BCBSNC Blue Advantage 2026 Tier 4 - Higher Cost Brand QL
BCBSNC Blue Value 2026 Tier 4 - Higher Cost Brand QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 17 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Tier 0 - $0 Copay (ACA Preventive) QL
NC State Health Plan - 70/30 Standard PPO 2026 Tier 0 - $0 Copay (ACA Preventive) QL
NC State Health Plan - 80/20 Plus PPO 2026 Tier 0 - $0 Copay (ACA Preventive) QL
Source: CMS QHP JSON  ·  Checked: 17 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 0 - $0 Preventive QL
Bronze Classic 4700 | with Atrium Health Tier 0 - $0 Preventive QL
Bronze Elite + PCP Saver Plus | with Atrium Health Tier 0 - $0 Preventive QL
Silver Classic | with Atrium Health Tier 0 - $0 Preventive QL
Silver Simple Diabetes | with Atrium Health Tier 0 - $0 Preventive QL
Silver Simple PCP Saver | with Atrium Health Tier 0 - $0 Preventive QL
Gold Elite Saver Plus | with Atrium Health Tier 0 - $0 Preventive QL
Bronze Simple Chronic Care CKM | with Atrium Health Tier 0 - $0 Preventive QL
Bronze Simple Diabetes | with Atrium Health Tier 0 - $0 Preventive QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health Tier 0 - $0 Preventive QL
Silver Simple Chronic Care CKM | with Atrium Health Tier 0 - $0 Preventive QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health Tier 0 - $0 Preventive QL
AIAN Cost Share Tier 0 - $0 Preventive QL
AIAN Cost Share | with Atrium Health Tier 0 - $0 Preventive QL
Bronze Classic Standard Tier 0 - $0 Preventive QL
Silver Classic Standard Tier 0 - $0 Preventive QL
Gold Classic Standard Tier 0 - $0 Preventive QL
Bronze Classic Standard | with Atrium Health Tier 0 - $0 Preventive QL
Silver Classic Standard | with Atrium Health Tier 0 - $0 Preventive QL
Gold Classic Standard | with Atrium Health Tier 0 - $0 Preventive QL
Bronze Elite + PCP Saver Plus Tier 0 - $0 Preventive QL
Silver Classic Tier 0 - $0 Preventive QL
Secure Tier 0 - $0 Preventive QL
Bronze Classic 4700 Tier 0 - $0 Preventive QL
Silver Simple PCP Saver Tier 0 - $0 Preventive QL
Gold Elite Saver Plus Tier 0 - $0 Preventive QL
Silver Simple Diabetes Tier 0 - $0 Preventive QL
Secure | with Atrium Health Tier 0 - $0 Preventive QL
Source: PDF  ·  Formulary date: Jun 23, 2026  ·  Checked: 17 hours, 26 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Silver Standard (No Referrals) Tier 0 - $0 Preventive QL
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) Tier 0 - $0 Preventive QL
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 0 - $0 Preventive QL
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) Tier 0 - $0 Preventive QL
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals Tier 0 - $0 Preventive QL
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals) Tier 0 - $0 Preventive QL
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals) Tier 0 - $0 Preventive QL
UHC Bronze Standard (No Referrals) Tier 0 - $0 Preventive QL
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Tier 0 - $0 Preventive QL
UHC Silver Value ($0 Virtual Urgent Care, No Referrals) Tier 0 - $0 Preventive QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Tier 0 - $0 Preventive QL
UHC Gold Standard (No Referrals) Tier 0 - $0 Preventive QL
UHC Bronze Standard+ Dental + Vision (No Referrals) Tier 0 - $0 Preventive QL
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