Aetna Student Health Contraceptives Formulary

Medications covered under the Aetna Student Health Plan*: 

ALTAVERA DEPO-SQ PROV JUNEL 1/20 LYZA ORTHO TRI- TRI-LO
ALYACEN DESO/ETHINYL JUNEL FE MARLISSA ORTHO-NOVUM TRI-LO-
AMETHIA DROSPIR/ETHI JUNEL FE 24 MEDROXYPR AC OVCON 50 TRINESSA
AMETHIA LO DROSPIRE/ETH KAITLIB FE MELODETTA OVCON-35 21 TRINESSA LO
AMETHYST DROSPIRENONE KARIVA MIBELAS 24 OVCON-35 28 TRI-NORINYL
APRI ELINEST KELNOR MICRGSTIN 24 OVRAL TRI-PREVIFEM
ARANELLE EMOQUETTE KIMIDESS MICROGESTIN OVULEN-21 TRI-SPRINTEC
ASHLYNA ENPRESSE-28 KURVELO MONO-LINYAH PHILITH TRIVORA-28
AUBRA ENSKYCE LARIN MONONESSA PIMTREA TRI-VYLIBRA
AVIANE ERRIN LARIN 24 MYZILRA PIRMELLA VELIVET
AZURETTE ESTARYLLA LARIN FE N.E.E. PORTIA-28 VESTURA
BALZIVA ETHY ETH EST LARISSIA NATAZIA PREVIFEM VIENVA
BEKYREE ETHYNODIOL LAYOLIS FE NECON QUASENSE VIORELE
BLISOVI 24 FALESSA LEENA NELOVA RAJANI VYFEMLA
BLISOVI FE FALMINA LESSINA NIKKI RECLIPSEN VYLIBRA
BRIELLYN FAYOSIM LEVO-ETH EST NORA-BE RIVELSA WERA
CAMILA FEMYNOR LEVONEST NORE/ETH/FER SAFYRAL WYMZYA FE
CAMRESE GIANVI LEVONOR/ETHI NORETH/ETHIN SETLAKIN XULANE
CAMRESE LO GILDAGIA LEVORA-21 NORETHIN SHAROBEL ZARAH
CAZIANT GILDESS LEVORA-28 NORETHINDRON SOLIA ZENCHENT
CESIA GILDESS 24 LILLOW NORGEST/ETHI SPRINTEC 28 ZENCHENT FE
CHATEAL GILDESS FE LO LOESTRIN NORINYL SRONYX ZOVIA 1/35E
CRYSELLE-28 HEATHER LO MINASTRIN NORLEST FE SYEDA ZOVIA 1/50E
CYCLAFEM INTROVALE LO/OVRAL NORLYDA TARINA FE  
CYRED ISIBLOOM LOESTRIN 21 NORLYROC TAYTULLA  
DASETTA JENCYCLA LOESTRIN FE NORTREL TILIA FE  
DAYSEE JOLESSA LOMEDIA 24 NUVARING TRI FEMYNOR  
DEBLITANE JOLIVETTE LORYNA OCELLA TRI-ESTARYLL  
DELYLA JULEBER LOW-OGESTREL OGESTREL TRI-LEGEST  
DEPO-PROVERA JUNEL 1.5/30 LUTERA ORSYTHIA TRI-LINYAH  

 

Updated 3/24/2018

*Subject to change