Women`s Preventive Health $0 Co-Pay Contraceptive

Women’s Preventive Health
$0 Co-Pay Contraceptive Drugs & Devices List
Under the Affordable Care Act, women of reproductive age in non-grandfathered plans are
covered for select methods of contraception at no share of cost by their health plan.
The following list of select contraceptive drugs and devices are available at no cost when
prescribed by a healthcare provider and obtained from a network provider. Members must
have a pharmacy benefit with Blue Shield of California to be covered for contraceptives
obtained from a pharmacy.
Please call the customer service phone number listed on your Blue Shield ID card for any
questions about contraceptive coverage.
Oral Contraceptives
One Phase - Monophasic
altavera
alyacen 1/35
amethia
amethia lo
amethyst
apri
ashlyna
aubra
aviane
balziva
blisovi fe
blisovi 24 fe
briellyn
camrese
camrese lo
chateal
cryselle
cyclafem
cyred
dasetta
daysee
delyla
elinest
emoquette
enskyce
estarylla
ethinyl estradiol-desogestrel
ethinyl estradiol-drospirenone
ethinyl estradiol-norethindrone
ethinyl estradiol-norethindrone-iron
falmina
Revised: 09/2016
gianvi
gildagia
gildess
gildess fe
gildess 24 fe
introvale
jencycla
jolessa
juleber
junel
junel fe
junel 24 fe
kaitlib fe
kelnor 1/35
kurvelo
larin 21
larin fe
larin 24 fe
larissia
layolis fe
lessina
levlen
levora
lomedia 24 fe
loryna
low-ogestrel
lutera
marlissa
microgestin
microgestin fe
microgestin 24fe
mono-linyah
mononessa
necon 0.5/35
necon 1/35
necon 1/50
nikki
nortrel
ocella
ogestrel 0.5/50
orsythia
philith
pirmella 1/35
portia
previfem
quasense
reclipsen
setlakin
sprintec
sronyx
syeda
tarina fe
vestura
vienva
vyfemla
wera
wymzya fe
zarah
zenchent
zenchent fe
zovia 1/35e
zovia 1/50e
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Two Phase – Biphasic
azurette
bekyree
kariva
Three Phase - Triphasic
alyacen 7/7/7
aranelle
caziant
cyclafem
dasetta
enpresse
ethinyl estradiol-norgestimate
leena
kimidess
necon 10/11
pimtrea
viorele
levonest
myzilra
necon 7/7/7
nortrel
pirmella 7/7/7
tilia fe
tri-estarylla
tri-legest fe
tri-linyah
tri-lo-estrylla
tri-lo-marzia
tri-lo-sprintec
trinessa
trinessa lo
tri-previfem
tri-sprintec
trivora
velivet
heather
jencycla
jolivette
lyza
nora-be
norethindrone 0.35mg
norlyroc
sharobel
Four Phase
Natazia
Progestin Only
camila
deblitane
errin
Additional Methods
Emergency Contraception
Vaginal Barriers
Implanted Rods*
Aftera
Omniflex diaphragm
Implanon
Econtra EZ
Wide seal diaphragm
Nexplanon
Ella
Femcap cervical cap
Fallback Solo
Prentif cervical cap
Intrauterine Devices
(IUD)*
Next Choice One Dose
Injectable*
Liletta™
Opcicon One-Step
medroxyprogesterone
Mirena
My Way
Option 2
Plan B One-Step
React
Take Action
Over-the-Counter Contraceptives
Paragard
Topical Patch
Skyla
xulane
Vaginal Ring
Nuvaring
Spermicides
Sponges
Female condoms
*This contraceptive method is covered through the medical benefit.
Revised: 09/2016
blueshieldca.com