Desogestrel 0.15 mg / Ethinyl Estradiol 0.02 mg / Ethinyl Estradiol 0.01 mg Tablet Pack (Generic for Azurette, Kariva, Viorele, and Mircette)

Coverage Level – 100%

Copay – $0

Limitations – No more than 90 days’ supply

Restrictions – Health Pals Mail Order Pharmacy Network

Comments – Generic for Azurette, Kariva, Viorele, and Mircette