Standard Health Pals Formulary
Estradiol 0.5 mg / Norethindrone 0.1 mg Tablet Pack (Generic for Activella 0.5/0.1)
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Activella 0.5 mg / 0.1 mg