| Pharmacy |
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| Oral Contraceptives Comparison Chart: |
Let our comparison chart help you review what category your oral contraceptive falls in.
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The formulary list was last updated on 09/01/07, please be advised the information listed may not reflect the most current data and may be updated at any time without notice.
Please call HNE Member Services at (413) 787-4000 or
(800) 310-2835 for assistance.
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| Drug Name |
Tier |
Type |
Manufacturer |
Estrogen (mcg) |
Progestin (mg) |
| Alesse |
Tier 3 |
Monophasic |
Wyeth |
ethinyl estradiol 20 |
levonorgestrel 0.1 |
| Apri |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 30 |
desogestrel 0.15 |
| Aranelle |
Tier 1 |
Triphasic |
Barr |
ethinyl estradiol 35 |
norethindrone 0.5 - 1 - 0.5 |
| Aviane |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 20 |
levonorgestrel 0.1 |
| Balziva |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 35 |
norethindrone 0.4 |
| Brevicon |
Tier 3 |
Monophasic |
Watson |
ethinyl estradiol 35 |
norethindrone 0.5 |
| Camila |
Tier 1 |
Progestin Only |
Barr |
Generic to Nor-Q.D. |
norethindrone 0.35 |
| Cesia |
Tier 1 |
Triphasic |
Prasco |
ethinyl estradiol 25 |
desogestrel 0.1 - 0.125 - 0.15 |
| Cryselle |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 30 |
norgestrel 0.3 |
| Cyclessa |
Tier 3 |
Triphasic |
Organon |
ethinyl estradiol 25 |
desogestrel 0.1 - 0.125 - 0.15 |
| Demulen 1/35 |
Tier 3 |
Monophasic |
Searle |
ethinyl estradiol 35 |
|
| Demulen 1/50 |
Tier 3 |
Monophasic |
Searle |
ethinyl estradiol 50 |
ethynodiol 1 |
| Desogen |
Tier 3 |
Monophasic |
Organon |
ethinyl estradiol 30 |
desogestrel 0.15 |
| Enpresse |
Tier 1 |
Triphasic |
Barr |
ethinyl estradiol 30 - 40 - 30 |
levonorgestrel 0.05 - 0.075 - 0.125 |
| Errin |
Tier 1 |
Progestin Only |
Barr |
Generic to Ortho Micronor |
norethindrone 0.35 |
| Estrostep FE |
Tier 2 |
Triphasic |
Parke Davis |
ethinyl estradiol 20 - 30 - 35 |
norethindrone 1 |
| Femcon FE (chewable) |
Tier 3 |
Monophasic |
Warner-Chilcott |
ethinyl estradiol 35 |
norethindrone 0.4 |
| Jolessa |
Tier 1 |
Monophasic |
Barr |
esthiyl estradiol 30; 10 |
levonorgestrel 0.15 |
| Jolivette |
Tier 1 |
Progestin Only |
Watson |
|
norethindrone 0.35 |
| Junel 1.5/30 |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 30 |
norethindrone 1.5 |
| Junel 1/20 |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 20 |
norethindrone 1 |
| Junel FE 1.5/30 |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 30 |
norethindrone 1.5 |
| Junel FE 1/20 |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 20 |
norethindrone 1 |
| Kariva |
Tier 1 |
Biphasic |
Barr |
ethinyl estradiol 20 - 10 |
desogestrel 0.15 |
| Kelnor 1/35 |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 35 |
ethynodiol 1 |
| Lessina |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 20 |
levonorgestrel 0.1 |
| Levlen |
Tier 1 |
Monophasic |
Berlex |
ethinyl estradiol 30 |
levonorgestrel 0.15 |
| Levlite |
Tier 3 |
Monophasic |
Berlex |
ethinyl estradiol 20 |
levonorgestrel 0.1 |
| Levora |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 30 |
levonorgestrel 0.15 |
| Lo/Ovral |
Tier 3 |
Monophasic |
Wyeth |
ethinyl estradiol 30 |
|
| Loestrin 1.5/30 |
Tier 3 |
Monophasic |
Barr |
ethinyl estradiol 30 |
norethindrone 1.5 |
| Loestrin 1/20 |
Tier 3 |
Monophasic |
Barr |
ethinyl estradiol 20 |
norethindrone 1 |
| Loestrin FE 1.5/30 |
Tier 3 |
Monophasic |
Barr |
ethinyl estradiol 30 |
norethindrone 1.5 |
| Loestrin FE 1/20 |
Tier 3 |
Monophasic |
Barr |
ethinyl estradiol 20 |
norethindrone 1 |
| Low-Ogestrel |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 30 |
norgestrel 0.3 |
| Lutera |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 20 |
levonorgestrel 0.1 |
| Microgestin 1.5/30 |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 30 |
norethindrone 1.5 |
| Microgestin FE 1.5/30 |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 30 |
norethindrone 1.5 |
| Microgestin FE 1/20 |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 20 |
norethindrone 1 |
| Mircette |
Tier 3 |
Biphasic |
Organon |
ethinyl estradiol 20 - 10 |
desogestrel 0.15 |
| Mircrogestin 1/20 |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 20 |
norethindrone 1 |
| Modicon |
Tier 3 |
Monophasic |
Ortho |
ethinyl estradiol 35 |
norethindrone 0.5 |
| Mononessa |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 35 |
norgestimate 0.25 |
| Necon 0.5/35 |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 35 |
norethindrone 0.5 |
| Necon 1/35 |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 35 |
norethindrone 1 |
| Necon 1/50 |
Tier 1 |
Monophasic |
Watson |
mestranol 50 |
norethindrone 1 |
| Necon 10/11 |
Tier 1 |
Biphasic |
Watson |
ethinyl estradiol 35 |
norethindrone 0.5 - 1 |
| Necon 777 |
Tier 1 |
Triphasic |
Watson |
ethinyl estradiol 35 |
norethindrone 0.5 - 0.75 - 1 |
| Nora-BE |
Tier 1 |
Progestin Only |
Watson |
Generic to Nor-Q.D. |
norethindrone 0.35 |
| Nordette |
Tier 3 |
Monophasic |
Monarch |
ethinyl estradiol 30 |
levonorgestrel 0.15 |
| Norinyl 1+35 |
Tier 3 |
Monophasic |
Watson |
ethinyl estradiol 35 |
norethindrone 1 |
| Norinyl 1+50 |
Tier 3 |
Monophasic |
Watson |
mestranol 50 |
norethindrone 1 |
| Nor-Q.D. |
Tier 1 |
Progestin Only |
Watson |
|
norethindrone 0.35 |
| Nortrel 0.5/35 |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 35 |
norethindrone 0.5 |
| Nortrel 1/35 |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 35 |
norethindrone 1 |
| Nortrel 777 |
Tier 1 |
Triphasic |
Barr |
ethinyl estradiol 35 |
norethindrone 0.5 - 0.75 - 1 |
| Nuva Ring |
Tier 3 |
Monophasic |
Organon |
ethinyl estradiol 15 |
etonogestrel 0.12 |
| Ogestrel |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 50 |
norgestrel 0.5 |
| Ortho Cyclen |
Tier 3 |
Monophasic |
Ortho |
ethinyl estradiol 35 |
norgestimate 0.25 |
| Ortho Micronor |
Tier 3 |
Progestin Only |
Ortho |
|
norethindrone 0.35 |
| Ortho TriCyclen |
Tier 3 |
Triphasic |
Ortho |
ethinyl estradiol 35 |
norgestimate 0.18 - 0.215 - 0.25 |
| Ortho TriCyclen Lo |
Tier 3 |
Triphasic |
Ortho |
ethinyl estradiol 25 |
norgestimate 0.18 - 0.215 - 0.25 |
| Ortho-Cept |
Tier 3 |
Monophasic |
Ortho |
ethinyl estradiol 30 |
desogestrel 0.15 |
| Ortho-Evra |
Tier 3 |
Monophasic |
Johnson&Johnson |
ethinyl estradiol 20 |
norelgestromin 0.15 |
| Ortho-Novum 1/35 |
Tier 3 |
Monophasic |
Ortho |
ethinyl estradiol 35 |
norethindrone 1 |
| Ortho-Novum 1/50 |
Tier 3 |
Monophasic |
Ortho |
mestranol 50 |
norethindrone 1 |
| Ortho-Novum 10/11 |
Tier 3 |
Biphasic |
Ortho |
ethinyl estradiol 35 |
norethindrone 0.5 - 1 |
| Ortho-Novum 777 |
Tier 3 |
Triphasic |
Ortho |
ethinyl estradiol 35 |
norethindrone 0.5 - 0.75 - 1 |
| Orvette |
Tier 3 |
Progestin Only |
Wyeth |
|
norgestrel 0.075 |
| Ovcon 35 |
Tier 3 |
Monophasic |
Warner-Chilcott |
ethinyl estradiol 35 |
norethindrone 0.4 |
| Ovcon 35 chewable |
Tier 3 |
Monophasic |
Warner-Chilcott |
ethinyl estradiol 35 |
norethindrone 0.4 |
| Ovcon 50 |
Tier 3 |
Monophasic |
Warner-Chilcott |
ethinyl estradiol 50 |
norethindrone 1 |
| Ovral |
Tier 3 |
Monophasic |
Wyeth |
ethinyl estradiol 50 |
norgestrel 0.5 |
| Portia |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 30 |
levonorgestrel 0.15 |
| Previfem |
Tier 1 |
Monophasic |
Teva |
ethinyl estradiol 35 |
norgestimate 0.25 |
| Quasense |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 30; 10 |
levonorgestrel 0.15 |
| Reclipsen |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 30 |
desogestrel 0.15 |
| Seasonale |
Tier 3 |
Monophasic |
Duramed |
ethinyl estradiol 30 |
levonorgestrel 0.15 |
| Seasonique |
Tier 3 |
Monophasic |
Duramed |
esthiyl estradiol 30; 10 |
levonorgestrel 0.15 |
| Solia |
Tier 1 |
Monophasic |
Prasco |
ethinyl estradiol 30 |
desogestrel 0.15 |
| Sprintec |
Tier 1 |
Monophasic |
Barr |
ethinyl estradiol 35 |
norgestimate 0.25 |
| Tri-Levlen |
Tier 1 |
Triphasic |
Berlex |
ethinyl estradiol 30 - 40 - 30 |
levonorgestrel 0.05 - 0.075 - 0.125 |
| TriNessa |
Tier 1 |
Triphasic |
Watson |
ethinyl estradiol 35 |
norgestimate 0.18 - 0.215 - 0.25 |
| Tri-Norinyl |
Tier 3 |
Triphasic |
Watson |
ethinyl estradiol 35 |
norethindrone 0.5 - 1 - 0.5 |
| Triphasil |
Tier 3 |
Triphasic |
Wyeth |
ethinyl estradiol 30 - 40 - 30 |
levonorgestrel 0.05 - 0.075 - 0.125 |
| Tri-Previfem |
Tier 1 |
Triphasic |
Teva |
ethinyl estradiol 35 |
norgestimate 0.18 - 0.215 - 0.25 |
| Tri-Sprintec |
Tier 1 |
Triphasic |
Barr |
ethinyl estradiol 35 |
norgestimate 0.18 - 0.215 - 0.25 |
| Trivora-28 |
Tier 1 |
Triphasic |
Watson |
ethinyl estradiol 30 - 40 - 30 |
levonorgestrel 0.05 - 0.075 - 0.125 |
| Velivet |
Tier 1 |
Triphasic |
Barr |
ethinyl estradiol 25 |
desogestrel 0.1 - 0.125 - 0.15 |
| Yasmin |
Tier 3 |
Monophasic |
Berlex |
ethinyl estradiol 30 |
drospirenone 3 |
| Yaz |
Tier 3 |
Monophasic |
Schering |
ethinyl estradiol 20 |
drospirenone 3 |
| Zovia 1/35 |
Tier 1
|
Monophasic |
Watson |
ethinyl estradiol 35 |
ethynodiol 1 |
| Zovia 1/50E |
Tier 1 |
Monophasic |
Watson |
ethinyl estradiol 50 |
ethynodiol 1 |
| Key: |
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| Tier 1 = lowest copayment |
(Generic drugs)** |
**NOTE- Brand name products with |
| Tier 2 = middle copayment |
|
generic equivalents default |
| Tier 3 = highest copayment |
|
to Tier 3; the generic defaults |
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to Tier 1. |
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