Norgestimate-Ethinyl Estradiol
0.18 mg (7)/0.215 mg (7)/0.25 mg (7) with 0.035 mg (28), 0.25 mg-0.035 mg — Tablet
Also known as:
Norgestimate-Ethinyl Estradiol 0.25-0.035 Mg Tablet
TRI-LINYAH
TRI-VYLIBRA
TRI-NYMYO
MILI
MONO-LINYAH
TRI-SPRINTEC
VYLIBRA
TRI-ESTARYLLA
TRI-MILI
SPRINTEC
ESTARYLLA
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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
24 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via Tri-Sprintec |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Focus 2026
via Estarylla |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Focus 2026
via Mili |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Focus 2026
via mono-linyah |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Focus 2026
via TRI-LINYAH |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Focus 2026
via tri-mili |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Focus 2026
via tri-vylibra |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Focus 2026
via vylibra |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Standard Option 2026
via Estarylla |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Standard Option 2026
via Mili |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Standard Option 2026
via mono-linyah |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Standard Option 2026
via TRI-LINYAH |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Standard Option 2026
via tri-mili |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Standard Option 2026
via Tri-Sprintec |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Standard Option 2026
via tri-vylibra |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Standard Option 2026
via vylibra |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Basic Option 2026
via Estarylla |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Basic Option 2026
via Mili |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Basic Option 2026
via mono-linyah |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Basic Option 2026
via TRI-LINYAH |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Basic Option 2026
via tri-mili |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Basic Option 2026
via Tri-Sprintec |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Basic Option 2026
via tri-vylibra |
Tier 1 - Generic | — | — | — NCTM | None |
|
BCBS Federal Basic Option 2026
via vylibra |
Tier 1 - Generic | — | — | — NCTM | None |
Cigna
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Cigna Plus NC 4-Tier Formulary 2026
via Tri-Sprintec |
Tier 1 - Generic | — | — | — | None |
|
Cigna Plus NC 4-Tier Formulary 2026
via TRI-LINYAH |
Tier 1 - Generic | — | — | — | None |
|
Cigna Plus NC 4-Tier Formulary 2026
via Tri-Estarylla |
Tier 1 - Generic | — | — | — | None |
| Cigna Plus NC 4-Tier Formulary 2026 | Tier 1 - Generic | — | — | — | None |
|
Cigna Plus NC 4-Tier Formulary 2026
via Mili |
Tier 1 - Generic | — | — | — | None |
|
Cigna Plus NC 4-Tier Formulary 2026
via Estarylla |
Tier 1 - Generic | — | — | — | None |
NC State Health Plan
24 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - HDHP 2026
via vylibra |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Tri-Sprintec |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Tri-Sprintec |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Tri-Sprintec |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via tri-vylibra |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via tri-vylibra |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via tri-vylibra |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via vylibra |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via vylibra |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Estarylla |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Estarylla |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Estarylla |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Mili |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Mili |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Mili |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via mono-linyah |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via mono-linyah |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via mono-linyah |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via TRI-LINYAH |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via TRI-LINYAH |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via TRI-LINYAH |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via tri-mili |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via tri-mili |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via tri-mili |
Tier 0 - $0 Copay (ACA Preventive) | — | — | — | None |
TRICARE
1 planUnitedHealthcare
7 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UnitedHealthcare NC Individual & Family 2026
via vylibra |
Tier 1 - $0 Copay Preventive | — | — | — | None |
|
UnitedHealthcare NC Individual & Family 2026
via tri-vylibra |
Tier 1 - $0 Copay Preventive | — | — | — | None |
|
UnitedHealthcare NC Individual & Family 2026
via Tri-Sprintec |
Tier 1 - $0 Copay Preventive | — | — | — | None |
|
UnitedHealthcare NC Individual & Family 2026
via TRI-LINYAH |
Tier 1 - $0 Copay Preventive | — | — | — | None |
|
UnitedHealthcare NC Individual & Family 2026
via Tri-Estarylla |
Tier 1 - $0 Copay Preventive | — | — | — | None |
|
UnitedHealthcare NC Individual & Family 2026
via mono-linyah |
Tier 1 - $0 Copay Preventive | — | — | — | None |
|
UnitedHealthcare NC Individual & Family 2026
via Estarylla |
Tier 1 - $0 Copay Preventive | — | — | — | None |