levonorgestrel-eth estra
0.05-30/0.075-40/0.125-30mg — Tablet
Also known as:
levonorgestrel-eth estra tab 0.05-30/0.075- 40/0.125-30mg-mcg
levonorgestrel-eth estra tab 0.05-30/0.075-40/0.125-30mg- mcg
levonorgestrel-eth estra tab 0.05-30/0.075-
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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.
Blue Cross Blue Shield Federal
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — NCTM | None |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — NCTM | None |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — NCTM | None |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Care 2026 | Tier A - ACA $0 Copay | — | — | — | None |
| BCBSNC Blue Value 2026 | Tier A - ACA $0 Copay | — | — | — | None |
| BCBSNC Blue Advantage 2026 | Tier A - ACA $0 Copay | — | — | — | None |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier A - ACA $0 Copay | — | — | — | None |
| BCBSNC Blue Local 2026 | Tier A - ACA $0 Copay | — | — | — | None |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
| NC State Health Plan - HDHP 2026 | Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |