Sample Notes Page - CareFirst BlueCross BlueShield
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: