drospir/eth estra/levomefol Ca

3-0.02(24), 3-0.03(21) — Tablet

CONTRACEPTIVE AGENTS

Also known as: SAFYRAL DROSPIRENONE-ETH ESTRA-LEVOMEF TYDEMY BEYAZ
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: Excel (XLSX)  ·  Formulary date: Jul 31, 2026  ·  Checked: 2 hours, 4 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 3 - Non-Formulary — — — None
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