Women’s Preventive Services Drug and Device List Lista de servicios de medicinas y dispositivos preventivos July 2021 In accordance with requirements put forth through the Affordable Care Act (ACA), we cover certain preventive drugs and services at $0. The following list of contraceptive drugs and devices may be available to you at no cost share when filled at a Truli Preferred pharmacy. This list is subject to the terms of your plan and may change based on ACA guideline updates.

Please refer to your benefit materials for coverage details and the plan website for current information as this publication is subject to change.

Cervical Caps Intrauterine Devices* Oral Combined Contraceptive Capuchones Cervicales Dispositivos Intrauterino* (cont) Femcap Liletta Combinado Oral Kyleena emoquette Diaphragms Mirena enpresse-28 Diafragmas Paragard enskyce Caya Skyla errin Omniflex Diaphragm estarylla Wide-Seal Diaphragm Oral Combined Contraceptive ethynodiol diacetate/ethinyl estradiol Combinado Oral falmina Emergency afirmelle femynor Emergencia altavera gemmily aftera alyacen gianvi econtra ez apri hailey econtra one-step aranelle isibloom Ella aubra jasmiel aubra eq juleber my choice aurovela junel my way aviane junel fe new day ayuna kaitlib fe opcicon one-step azurette kalliga option 2 balziva kariva preventeza bekyree kelnor react blisovi fe kurvelo take action briellyn larin caziant larin fe Female chateal larissia Condones Femeninos chateal eq layolis fe FC Female cryselle-28 leena FC2 cyclafem lessina c yred levonest Implants Progestin* cyred eq levonorgestrel/ethinyl estradiol Implantes de Progestina* dasetta levora Nexplanon delyla lillow desogestrel/ethinyl estradiol loestrin fe Injectable Progestin* drospirenone/ethinyl estradiol loryna Progestina Inyectable* drospirenone/ethinyl estradiol/levomefolate low-ogestrel medroxyprogesterone 150 mg elinest lo-zumandimine

*May be covered under your medical benefit Generics = lowercase Brands = UPPERCASE Genéricos = letra minúscula Marca = LETRAS MAYÚSCULA

1 Health coverage is offered by Truli for Health, an affiliate of Florida Blue. These companies are Independent Licensees of the Blue Cross and Blue Shield Association.

Oral Combined Contraceptive Oral Combined Contraceptive Spermicide (cont) (cont) Espermicida Combinado Oral Combinado Oral Encare lutera viorele Options Conceptrol marlissa volnea Options Gynol II microgestin 24 fe vyfemla Shur-Seal microgestin vylibra VCF Vaginal Contraceptive Film microgestin fe wera VCF Vaginal Contraceptive Foam mili zarah vcf vaginal contraceptive gel mono-linyah zovia mononessa zumandimine Sponge myzilra Esponja necon Oral Ext Continuous Contraceptive Today Sponge nikki Ext Oral Continua norethindrone/ethinyl estradiol amethia Procedures* norethindrone/ethinyl estradiol/fe amethia lo Procedimientos de Esterilización* norgestimate/ethinyl estradiol amethyst nortrel ashlyna ocella camrese orsythia camrese lo Transdermal Combined philith daysee Combinado Transdermal pimtrea fayosin Xulane pirmella introvale portia-28 jaimiess Vaginal Combined previfem jolessa Combinado Vaginal reclipsen levonorgestrel/ethinyl estradiol eluryng simliya lojaimiess /ethinyl estradiol sprintec 28 quasense Nuvaring sronyx rivelsa syeda setlakin tarina fe simpesse tilia fe tri-estarylla Oral Progestin Contraceptive tri-femynor Progenstina Oral tri-legest fe camila tri-linyah deblitane tri-lo-estarylla errin tri-lo-marzia heather tri-lo-sprintec incassia tri-mili jencycla tri-previfem jolivette tri-sprintec lyza trivora-28 nora-be tri-vylibra norethindrone 0.35 mg tri-vylibra lo norlyda tydemy norlyroc velivet sharobel vienva tulana

*May be covered under your medical benefit Generics = lowercase Brands = UPPERCASE Genéricos = letra minúscula Marca = LETRAS MAYÚSCULA

2 Health coverage is offered by Truli for Health, an affiliate of Florida Blue. These companies are Independent Licensees of the Blue Cross and Blue Shield Association.