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: 11 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Signature Expanded Bronze + Vision + Adult Dental Tier 0 - $0 Preventive — — — None
Signature Silver + Vision + Adult Dental Tier 0 - $0 Preventive — — — None
Signature Gold + Vision + Adult Dental Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive — — — None
Signature Silver with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive — — — None
Signature Gold with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive — — — None
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental Tier 0 - $0 Preventive — — — None
Clear Silver with $0 Insulin Options Tier 0 - $0 Preventive — — — None
Signature Expanded Bronze Tier 0 - $0 Preventive — — — None
Signature Silver Tier 0 - $0 Preventive — — — None
Signature Gold Tier 0 - $0 Preventive — — — None
Everyday Bronze with Atrium Health 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
Signature Expanded Bronze with Atrium Health Tier 0 - $0 Preventive — — — None
Signature Silver with Atrium Health Tier 0 - $0 Preventive — — — None
Signature Gold with Atrium Health Tier 0 - $0 Preventive — — — None
Enhanced Asthma/COPD Care Silver $0 Rx 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
Complete Gold with Atrium Health + Vision + Adult Dental Tier 0 - $0 Preventive — — — None
Complete Gold Tier 0 - $0 Preventive — — — None
Enhanced Asthma/COPD Care Silver $0 Rx Options Tier 0 - $0 Preventive — — — None
Everyday Bronze Tier 0 - $0 Preventive — — — None
Clear Silver with $0 Insulin Options + Vision + Adult Dental Tier 0 - $0 Preventive — — — None
Elite Bronze Tier 0 - $0 Preventive — — — None
Streamlined Silver Tier 0 - $0 Preventive — — — None
Streamlined Silver with Atrium Health Tier 0 - $0 Preventive — — — None
Enhanced CHF Heart Care Silver $0 Rx Options Tier 0 - $0 Preventive — — — None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 11 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026 Tier 2 - Preferred Brand — — — NCTM None
BCBS Federal Focus 2026 Tier 2 - Preferred Brand — — — NCTM None
BCBS Federal Standard Option 2026 Tier 2 - Preferred Brand — — — NCTM None
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 11 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Value 2026 Tier 4 - Higher Cost Brand — — ✓ QL
BCBSNC Blue Care 2026 Tier 4 - Higher Cost Brand — — ✓ QL
BCBSNC Blue Advantage 2026 Tier 4 - Higher Cost Brand — — ✓ QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 4 - Higher Cost Brand — — ✓ QL
BCBSNC Blue Local 2026 Tier 4 - Higher Cost Brand — — ✓ QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 11 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 Tier 0 - $0 Copay (ACA Preventive) — — ✓ QL
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
Source: CMS QHP JSON  ·  Checked: 11 hours, 8 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 Simple Chronic Care CKM | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Secure | with Atrium Health Tier 0 - $0 Preventive — — ✓ QL
Gold Elite Saver Plus Tier 0 - $0 Preventive — — ✓ QL
Silver Simple Diabetes 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 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 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
Secure Tier 0 - $0 Preventive — — ✓ QL
Silver Classic Tier 0 - $0 Preventive — — ✓ QL
Bronze Elite + PCP Saver Plus Tier 0 - $0 Preventive — — ✓ QL
Bronze Classic 4700 Tier 0 - $0 Preventive — — ✓ QL
Silver Simple PCP Saver Tier 0 - $0 Preventive — — ✓ QL
Source: PDF  ·  Formulary date: Sep 23, 2026  ·  Checked: 11 hours, 8 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
UHC Bronze Standard (HSA, $0 Insulin, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, 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 Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, 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 Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) Tier 0 - $0 Preventive — — ✓ QL
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