levonorgestrel/ethin.estradiol

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

CONTRACEPTIVE AGENTS

Also known as: AMETHYST LEVONORGESTREL-ETH ESTRADIOL TYBLUME DOLISHALE TWIRLA Levonorgestrel-eth Estradiol
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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: Oct 29, 2026  ·  Checked: 3 hours, 52 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Generic Formulary (Basic Core) — — — None
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