FillMapBSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay) · 40788-40788TX0460003-0About this plan

Does BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay) cover ethinyl estradiol / norethindrone?

1 · Your plan

BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay)

40788-40788TX0460003-0 · ACA · ACA Marketplace

2 · Your medication

ethinyl estradiol / norethindrone

ethinyl estradiol / norethindroneunder BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay)

Covered — some forms require step therapy

14 of 20 covered forms have a condition attached. You may need to try a cheaper medication first — your doctor’s office handles it.

What you'd pay

$20per 30-day fill

From the first fill — no deductible on this drug.

This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.

Tier: Generic
Approval first: Not needed
Try another first: Required
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.

Your cost-sharing levelMarketplace plans publish a different amount for each level. Your eligibility notice says which applies. Nothing here is saved.

Covered forms and strengths (20)

{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } PackTry another first
{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Aurovela 1/20 21 Day]Try another first
{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Junel 1/20 21 Day]Try another first
{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Larin 1/20]Try another first
{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Loestrin 1/20 21 Day]Try another first
{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Microgestin 1/20 21 Day]Try another first
{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } PackTry another first
{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Aurovela 1.5/30 21 Day]Try another first
{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Hailey 1.5/30 21 Day]Try another first
{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Junel 1.5/30 21 Day]Try another first
{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Larin 1.5/30]Try another first
{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Loestrin 1.5/30 21 Day]Try another first
{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Microgestin 1.5/30 21 Day]Try another first
{21 (ethinyl estradiol 0.035 MG / norethindrone 1 MG Oral Tablet) } Pack [Nortrel 1/35 21 Day]Try another first
{28 (ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet) } Pack
{28 (ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet) } Pack
ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]
ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet
ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet [Fyavolv]
ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet [Jinteli]

← All coverage for ethinyl estradiol / norethindrone