levonorgestrel/ethin.estradiol

0.1-0.02MG, 120-30/24H, 90-20 MCG — Tablet

Also known as: AMETHYST LEVONORGESTREL-ETH ESTRADIOL TYBLUME DOLISHALE TWIRLA

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: Jul 31, 2026 · Checked: 2 hours, 5 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	—	PA