Standard Health Pals Formulary
Norethindrone 1 mg / Ethinyl Estradiol 0.035 mg Tablet Pack (Generic for Ortho Novum 1/35and Alyacen 1/35)
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Ortho Novum 1/35 and Alyacen 1/35