Drospirenone-eth Estra-levomef

Generic: drospir/eth estra/levomefol Ca

3-0.02(24), 3-0.03(21) — Tablet

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

1 plan

Source: Excel (XLSX) · Formulary date: Sep 23, 2026 · Checked: 8 hours, 55 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	—	None