FillMapDevoted Choice Giveback 002 Ok (PPO)

Does Devoted Choice Giveback 002 Ok (PPO) cover ethinyl estradiol / norethindrone?

Devoted Choice Giveback 002 Ok (PPO)
H2845-002-0 · MA_LOCAL · Medicare Part D
ethinyl estradiol / norethindrone
Do you get help with your Medicare drug costs?None of these

Optional. Some plans charge less at a preferred pharmacy. Enter your ZIP to see which pharmacies near you take this plan — pick yours and the price above is re-worked for it. Until you do, we show what a standard pharmacy costs. Nothing here is saved.

ethinyl estradiol / norethindroneunder Devoted Choice Giveback 002 Ok (PPO)
Covered — just walk in
Nothing to clear first — take the prescription to an in-network pharmacy.
What you'd pay
$3per 30-day fill

Part D caps what you pay out of pocket at $2,100 for 2026. From the first fill — no deductible on this drug.

This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.

Tier
Tier 2
Approval first
Not needed
Try another first
No
Amount limit
None
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 16, 2026 · CMS Part D monthly PUF. Reference information, not medical advice and not a price.

Covered forms and strengths (17)

  • {21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } PackTier 2
  • {21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Junel 1/20 21 Day]Tier 2
  • {21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Larin 1/20]Tier 2
  • {21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Loestrin 1/20 21 Day]Tier 2
  • {21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Luizza 1/20 21 Day]Tier 2
  • {21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Microgestin 1/20 21 Day]Tier 2
  • {21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Junel 1.5/30 21 Day]Tier 2
  • {21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Larin 1.5/30]Tier 2
  • {21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Loestrin 1.5/30 21 Day]Tier 2
  • {21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Luizza 1.5/30 21 Day]Tier 2
  • {21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Microgestin 1.5/30 21 Day]Tier 2
  • {21 (ethinyl estradiol 0.035 MG / norethindrone 1 MG Oral Tablet) } Pack [Nortrel 1/35 21 Day]Tier 2
  • {28 (ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet) } PackTier 3
  • {28 (ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet) } PackTier 3
  • ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]Tier 3
  • ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet [Fyavolv]Tier 3
  • ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet [Jinteli]Tier 3

← All coverage for ethinyl estradiol / norethindrone