Standard Health Pals Formulary
Estradiol 1 mg / Norethindrone 0.5 mg Tablet Pack (Generic for Activella 1/0.5)
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Activella 1 mg / 0.5 mg