Sample Notes Page - CareFirst BlueCross BlueShield
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Prescription Drug Detail
Brand Name
Brand Tier
Generic Name
Generic Tier
ESTROSTEP FE
(Tier
3
)
ethinyl estradiol/norethindrone acetate
(Tier
1
)
Prior Authorization Required:
No
Quantity Limit:
No
Category:
OB-GYN\Birth control pills (triphasic contraceptives)
Maintenance Drug:
Yes
Notes:
Generic available 10-29-2007; therefore, Estrostep FE moved to tier 3.
Attachments:
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