FillMapAnthem Clear Choice Silver X Tiered 4000

Does Anthem Clear Choice Silver X Tiered 4000 cover ethinyl estradiol / levonorgestrel?

Anthem Clear Choice Silver X Tiered 4000
48396-48396ME0710090-0 · ACA · ACA Marketplace
ethinyl estradiol / levonorgestrel
ethinyl estradiol / levonorgestrelunder Anthem Clear Choice Silver X Tiered 4000
Covered — just walk in
Nothing to clear first — take the prescription to an in-network pharmacy.
What you'd pay

This plan doesn't publish a price for this tier. Your pharmacy can quote it before you fill.

Tier
Tier one
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 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Covered forms and strengths (20)

  • {28 (ethinyl estradiol 0.02 MG / levonorgestrel 0.09 MG Oral Tablet) } Pack
  • {28 (ethinyl estradiol 0.02 MG / levonorgestrel 0.09 MG Oral Tablet) } Pack [Amethyst 28 Day]
  • {28 (ethinyl estradiol 0.02 MG / levonorgestrel 0.09 MG Oral Tablet) } Pack [Dolishale 28 Day]
  • {3 (168 HR ethinyl estradiol 0.00125 MG/HR / levonorgestrel 0.005 MG/HR Transdermal System [Twirla]) } Pack [Twirla 3 Count Weekly Patch]
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 42 (ethinyl estradiol 0.02 MG / levonorgestrel 0.15 MG Oral Tablet) / 21 (ethinyl estradiol 0.025 MG / levonorgestrel 0.15 MG Oral Tablet) / 21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 42 (ethinyl estradiol 0.02 MG / levonorgestrel 0.15 MG Oral Tablet) / 21 (ethinyl estradiol 0.025 MG / levonorgestrel 0.15 MG Oral Tablet) / 21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Rivelsa 91 Day]
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 42 (ethinyl estradiol 0.02 MG / levonorgestrel 0.15 MG Oral Tablet) / 21 (ethinyl estradiol 0.025 MG / levonorgestrel 0.15 MG Oral Tablet) / 21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Rosyrah 91 Day]
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.02 MG / levonorgestrel 0.1 MG Oral Tablet) } Pack
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.02 MG / levonorgestrel 0.1 MG Oral Tablet) } Pack [CamreseLo 91 Day]
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.02 MG / levonorgestrel 0.1 MG Oral Tablet) } Pack [Lojaimiess 91 Day]
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Ashlyna 91 Day]
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Camrese 91 Day]
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Daysee 91 Day]
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Jaimiess 91 Day]
  • {7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Simpesse 91 Day]
  • 168 HR ethinyl estradiol 0.00125 MG/HR / levonorgestrel 0.005 MG/HR Transdermal System [Twirla]
  • ethinyl estradiol 0.02 MG / levonorgestrel 0.09 MG Oral Tablet
  • ethinyl estradiol 0.02 MG / levonorgestrel 0.1 MG Oral Tablet
  • ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet

← All coverage for ethinyl estradiol / levonorgestrel