{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day]
ethinyl estradiol
RxCUI: 2696888
What the CMS Formulary Data Shows for {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day]
Per the CMS 2026 Part D formulary file, {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day] (RxNorm concept RXCUI 2696888, generic name ethinyl estradiol) appears on 15 distinct formulary files spanning 876 Medicare Part D plan offerings - 17.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.
Real-world access to {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day] today.
Coverage Details
- Formularies covering
- 15
- Plans covering
- 876
- Coverage rate
- 17.3%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day]
26 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Basic Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
| Humana Value Rx Plan (PDP) | Humana Insurance Co. & Humana Insurance Co. of NY | T4 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day]
74 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T1 | No | $0 | CA |
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T2 | No | $0 | CA |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T2 | No | $0 | MA |
| Mass General Brigham Advantage Secure (HMO-POS) | Mass General Brigham Health Plan, Inc. | T2 | No | $62.00 | MA |
| Mass General Brigham Advantage Premier (PPO) | Mass General Brigham Health Plan, Inc. | T2 | No | $79.70 | MA |
| Mass General Brigham Advantage Signature (PPO) | Mass General Brigham Health Plan, Inc. | T2 | No | $147.20 | MA |
| UPMC for Life HMO Premier Rx (HMO) | UPMC HEALTH PLAN, INC. | T4 | No | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T4 | No | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T4 | No | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T4 | No | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T4 | No | $0 | PA |
| UPMC for Life PPO Essential Care Rx (PPO) | UPMC HEALTH NETWORK, INC. | T4 | No | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC HEALTH COVERAGE, INC. | T4 | No | $0 | PA |
| Humana Gold Plus H0028-014 (HMO) | CHA HMO, INC. | T4 | No | $0 | IL, MO |
| Humana Gold Plus H0028-019 (HMO) | CHA HMO, INC. | T4 | No | $0 | NM |
| Humana Gold Plus H0028-021 (HMO) | CHA HMO, INC. | T4 | No | $0 | AZ |
| Humana Gold Plus H0028-024 (HMO) | CHA HMO, INC. | T4 | No | $0 | AZ |
| Humana Gold Plus H0028-028 (HMO) | CHA HMO, INC. | T4 | No | $0 | AZ |
| Humana Gold Plus H0028-029 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-030 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus SNP-DE H0028-032 (HMO D-SNP) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-035 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus SNP-DE H0028-036 (HMO D-SNP) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-037 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-041 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-042 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-043 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-046 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-053 (HMO) | CHA HMO, INC. | T4 | No | $0 | IA, NE |
| Humana Gold Plus H0028-054 (HMO-POS) | CHA HMO, INC. | T4 | No | $0 | KS, MO |
| Humana Gold Plus H0028-059 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-062 (HMO) | CHA HMO, INC. | T4 | No | $0 | AZ |
| Humana Essentials Plus Giveback H0028-063 (HMO) | CHA HMO, INC. | T4 | No | $0 | CO |
| Humana Gold Plus Giveback H0028-065 (HMO) | CHA HMO, INC. | T4 | No | $0 | IL, MO |
| Humana Gold Plus Giveback H0028-066 (HMO-POS) | CHA HMO, INC. | T4 | No | $0 | KS, MO |
| Humana Gold Plus H0028-072 (HMO) | CHA HMO, INC. | T4 | No | $0 | TX |
| Humana Gold Plus H0028-074 (HMO) | CHA HMO, INC. | T4 | No | $0 | AZ |
| Humana Dual Select H0028-078 (HMO D-SNP) | CHA HMO, INC. | T4 | No | $0 | CO |
| Humana Dual Select H0028-079 (HMO D-SNP) | CHA HMO, INC. | T4 | No | $0 | CO |
| Humana Gold Plus SNP-DE H0028-080 (HMO D-SNP) | CHA HMO, INC. | T4 | No | $0 | NE |
| Humana Total Complete H0028-081 (HMO) | CHA HMO, INC. | T4 | No | $0 | CO |
| Humana Gold Plus H0028-082 (HMO) | CHA HMO, INC. | T4 | No | $0 | HI |
| Humana Community (HMO) | HUMANA HEALTH PLAN OF OHIO, INC. | T4 | No | $0 | KY |
| Humana Gold Plus H0292-002 (HMO) | HUMANA HEALTH PLAN OF OHIO, INC. | T4 | No | $0 | KY |
| Humana Gold Plus H0292-003 (HMO) | HUMANA HEALTH PLAN OF OHIO, INC. | T4 | No | $0 | KY |
| HumanaChoice H0473-004 (PPO) | HUMANA INSURANCE COMPANY OF KENTUCKY | T4 | No | $0 | TX |
| HumanaChoice H0473-005 (PPO) | HUMANA INSURANCE COMPANY OF KENTUCKY | T4 | No | $0 | TX |
| Humana Gold Plus H0783-004 (HMO) | HUMANA BENEFIT PLAN OF TEXAS, INC. | T4 | No | $0 | TX |
Frequently Asked Questions
Is {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day] covered by Medicare Part D?
Yes, {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day] is covered by 876 Medicare Part D plans (17.3% of all Part D formularies).
What tier is {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day] on Medicare Part D plans?
{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day] averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 4.
Does {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day] require prior authorization?
0% of Part D formularies require prior authorization for {24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Disintegrating Oral Tablet) / 4 (inert ingredients 1 MG Disintegrating Oral Tablet) } Pack [Femlyv 24 ODT 28 Day]. Step therapy: 0%. Quantity limits: 0%.
Read our methodology - how this data is sourced, computed, and verified.