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Etonogestrel / ethinyl estradiol (vaginal ring) — plans on this site that list it on Tier 4
189 plans published on this site list this drug on Tier 4, grouped by company. Plans are sold by county — the service area under each plan shows where it is offered.
AMH Health
5 plans on this site
- Anthem I MaineHealth Advantage Choice (HMO-POS) — Offered in ME: Cumberland, York
- Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) — Offered in ME: 14 counties
- Anthem I MaineHealth Advantage Plus (HMO) — Offered in ME: Androscoggin, Franklin, Kennebec, Knox, Lincoln, Oxford, Penobscot, Sagadahoc, Somerset, Waldo
- Anthem | MaineHealth Chronic Care (HMO-POS C-SNP) — Offered in ME: Cumberland, York
- Anthem | MaineHealth Dual Advantage (HMO D-SNP) — Offered in ME: 14 counties
Align powered by Sanford Health Plan
2 plans on this site
- Align SecureChoice (PPO) — Offered in IA: Lyon, O'Brien, Osceola, Sioux; ND: 17 counties; SD: 19 counties
- Align SecureChoice Gold (PPO) — Offered in IA: Lyon, O'Brien, Osceola, Sioux; ND: 17 counties; SD: 19 counties
AlohaCare
1 plan on this site
- AlohaCare Advantage Plus (HMO D-SNP) — Offered in HI: Hawaii, Honolulu, Kalawao, Kauai, Maui
AmeriHealth Caritas VIP Care (HMO-D-SNP)
1 plan on this site
- AmeriHealth Caritas VIP Care Choice (HMO D-SNP) — Offered in DE: Kent, New Castle, Sussex
Anthem Blue Cross
7 plans on this site
- Anthem Full Dual Advantage Aligned (HMO D-SNP) — Offered in CA: Fresno, Kern, Kings, Madera, Sacramento, San Francisco, Santa Clara, Tulare
- Anthem I CareMore Chronic Care (HMO-POS C-SNP) — Offered in CA: Los Angeles, Orange
- Anthem I CareMore Home Care (HMO I-SNP) — Offered in CA: Los Angeles, Orange
- Anthem I CareMore Kidney Care (HMO-POS C-SNP) — Offered in CA: Los Angeles, Orange
- Anthem I CareMore Lung Care (HMO-POS C-SNP) — Offered in CA: Los Angeles, Orange
- Anthem I CareMore Medicare Advantage 2 (HMO-POS) — Offered in CA: Los Angeles, Orange, San Bernardino
- Anthem Select (HMO-POS) — Offered in CA: Los Angeles, Orange
Anthem Blue Cross Partnership Plan
5 plans on this site
- Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP) — Offered in CA: Los Angeles, Orange
- Anthem I CareMore Lung Care 2 (HMO-POS C-SNP) — Offered in CA: Los Angeles, Orange
- Anthem I CareMore Medicare Advantage (HMO-POS) — Offered in CA: Los Angeles, Orange
- Anthem I CareMore Premium Savings (HMO-POS) — Offered in CA: Los Angeles, Orange, San Bernardino
- Anthem Prime (HMO-POS) — Offered in CA: Kern, Marin, San Mateo, Stanislaus
Anthem Blue Cross and Blue Shield
24 plans on this site
- Anthem Chronic Care Advantage (HMO C-SNP) — Offered in KY: 120 counties
- Anthem Chronic Care Advantage (PPO C-SNP) — Offered in CA: Butte, Napa, Shasta, Solano, Sonoma, Sutter, Tehama, Yuba
- Anthem Dual Advantage (HMO D-SNP) — Offered in GA: 150 counties
- Anthem Dual Advantage Plus (PPO D-SNP) — Offered in VA: 127 counties
- Anthem Extra Help (HMO-POS) — Offered in OH: 88 counties
- Anthem Full Dual Advantage (HMO D-SNP) — Offered in GA: 150 counties
- Anthem Full Dual Advantage (PPO D-SNP) — Offered in CT: Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland, Windham
- Anthem Full Dual Advantage Select (HMO D-SNP) — Offered in CT: Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland, Windham
- Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) — Offered in OH: 88 counties
- Anthem I MyCare Ohio Full Dual Support (HMO D-SNP) — Offered in OH: 88 counties
- Anthem I PathWays Dual Care Advantage (HMO D-SNP) — Offered in IN: 92 counties
- Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) — Offered in IN: 92 counties
- Anthem Kidney Care (HMO-POS C-SNP) — Offered in GA: 145 counties
- Anthem Kidney Care (PPO C-SNP) — Offered in CA: 12 counties
- Anthem Medicare Advantage (HMO) — Offered in CT: Hartford, Litchfield, Middlesex, New London, Tolland, Windham
- Anthem Medicare Advantage (HMO-POS) — Offered in KY: 97 counties
- Anthem Medicare Advantage (PPO) — Offered in KY: 120 counties
- Anthem Medicare Advantage (Regional PPO) — Offered in IN: 92 counties; KY: 120 counties
- Anthem Medicare Advantage 2 (HMO-POS) — Offered in KY: 97 counties
- Anthem Medicare Advantage 2 (PPO) — Offered in IN: 72 counties
- Anthem Medicare Advantage 3 (PPO) — Offered in KY: 120 counties
- Anthem Medicare Advantage 4 (PPO) — Offered in OH: 17 counties
- Anthem Medicare Advantage 6 (HMO-POS) — Offered in IN: 42 counties
- Anthem Medicare Advantage 7 (HMO-POS) — Offered in IN: 42 counties
Anthem Blue Cross and Blue Shield HP
2 plans on this site
- Anthem HealthPlus Full Dual Advantage (HMO D-SNP) — Offered in NY: 11 counties
- Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) — Offered in NY: Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk, Westchester
Anthem HealthKeepers
5 plans on this site
- Anthem Chronic Care (HMO-POS C-SNP) — Offered in VA: 18 counties
- Anthem Dual Advantage Plus (HMO D-SNP) — Offered in VA: 133 counties
- Anthem Full Dual Advantage 2 (HMO D-SNP) — Offered in MO: 85 counties
- Anthem Full Dual Advantage Support (HMO D-SNP) — Offered in VA: 133 counties
- Anthem Medicare Advantage 4 (HMO-POS) — Offered in IN: 38 counties
Blue Cross Blue Shield of Arizona (AZ Blue)
3 plans on this site
- Blue Best Life Classic (HMO) — Offered in AZ: Maricopa, Pinal
- Blue Best Life Plus (HMO) — Offered in AZ: Maricopa, Pinal
- Blue Best Life Select (HMO) — Offered in AZ: Maricopa, Pinal
Blue Cross Blue Shield of South Carolina
2 plans on this site
- BlueCross Total (PPO) — Offered in SC: 12 counties
- BlueCross Total Value (PPO) — Offered in SC: 15 counties
Blue Cross and Blue Shield of North Carolina
5 plans on this site
- Blue Medicare Enhanced (HMO-POS) — Offered in NC: 42 counties
- Blue Medicare Essential (HMO) — Offered in NC: 80 counties
- Blue Medicare Essential Plus (HMO-POS) — Offered in NC: 42 counties
- Blue Medicare PPO Enhanced (PPO) — Offered in NC: 61 counties
- Healthy Blue + Medicare (HMO-POS D-SNP) — Offered in NC: 100 counties
Clover Health
8 plans on this site
- Clover Health Choice (PPO) — Offered in NJ: 12 counties
- Clover Health Choice Giveback (PPO) — Offered in NJ: 20 counties
- Clover Health Choice Value (PPO) — Offered in NJ: 12 counties
- Clover Health Classic (HMO) — Offered in NJ: Atlantic, Bergen, Essex, Hudson, Passaic, Union
- Clover Health LiveHealthy (PPO) — Offered in GA: 151 counties
- Clover Health LiveHealthy Giveback (PPO) — Offered in GA: 139 counties; SC: 12 counties
- Clover Health LiveHealthy Premier (PPO) — Offered in GA: 151 counties
- Clover Health Value (HMO) — Offered in NJ: Atlantic, Bergen, Essex, Hudson, Middlesex, Passaic, Union
First Choice VIP Care (HMO D-SNP)
1 plan on this site
- First Choice VIP Care (HMO D-SNP) — Offered in SC: 46 counties
Geisinger Gold
9 plans on this site
- Geisinger Gold Classic 360 Rx (HMO) — Offered in PA: 19 counties
- Geisinger Gold Classic Advantage Rx (HMO) — Offered in PA: 21 counties
- Geisinger Gold Classic Complete Rx (HMO) — Offered in PA: 37 counties
- Geisinger Gold Classic Essential Rx (HMO) — Offered in PA: 44 counties
- Geisinger Gold Preferred Advantage Rx (PPO) — Offered in PA: 29 counties
- Geisinger Gold Preferred Balance Rx (PPO) — Offered in PA: 44 counties
- Geisinger Gold Preferred Complete Rx (PPO) — Offered in PA: 44 counties
- Geisinger Gold Secure Rx (HMO D-SNP) — Offered in PA: 63 counties
- Geisinger Gold Value Rx (HMO) — Offered in PA: 63 counties
Great Plains Medicare Advantage
3 plans on this site
- Great Plain Medicare Advantage Gold (HMO I-SNP) — Offered in IA: Fremont, Harrison, Lyon, Mills, Montgomery, Plymouth, Pottawattamie, Shelby; ND: 19 counties; SD: 23 counties
- Great Plains Medicare Advantage (HMO I-SNP) — Offered in NE: 56 counties
- Great Plains Medicare Advantage Gold (HMO I-SNP) — Offered in NE: 56 counties
Health New England Medicare Advantage Plans
6 plans on this site
- Health New England Medicare Compass (PPO) — Offered in MA: Franklin, Hampden, Hampshire
- Health New England Medicare Plus (HMO) — Offered in MA: Berkshire, Franklin, Hampden, Hampshire
- Health New England Medicare Premium (HMO) — Offered in MA: Berkshire, Franklin, Hampden, Hampshire
- Health New England Medicare Select (HMO) — Offered in MA: Franklin, Hampden, Hampshire
- Health New England Medicare Standard (HMO) — Offered in MA: Berkshire
- Health New England Medicare Value (HMO) — Offered in MA: Franklin, Hampden, Hampshire
HealthSun Health Plans, Inc.
6 plans on this site
- HealthSun HealthAdvantage Plan (HMO) — Offered in FL: Miami-Dade
- HealthSun HealthAdvantage Plus (HMO) — Offered in FL: Miami-Dade
- HealthSun MediMax (HMO) — Offered in FL: Broward, Miami-Dade
- HealthSun MediSun Extra (HMO D-SNP) — Offered in FL: Broward, Miami-Dade, Palm Beach
- HealthSun MediSun Full Dual Extra (HMO D-SNP) — Offered in FL: Broward, Miami-Dade, Palm Beach
- HealthSun VitalCare (HMO C-SNP) — Offered in FL: Broward, Miami-Dade
Healthy Blue
3 plans on this site
- Healthy Blue Dual Advantage (HMO D-SNP) — Offered in LA: 64 counties
- Healthy Blue Enhanced Care (HMO D-SNP) — Offered in LA: 64 counties
- Healthy Blue Full Dual Advantage (HMO D-SNP) — Offered in KS: 84 counties
KelseyCare Advantage
2 plans on this site
- KelseyCare Advantage Freedom (HMO-POS) — Offered in TX: 13 counties
- KelseyCare Advantage Signature (HMO) — Offered in TX: Brazoria, Fort Bend, Galveston, Harris, Montgomery
MyAdvocate Medicare Advantage
2 plans on this site
- MyAdvocate Medicare Advantage GOLD (HMO-POS) — Offered in NE: 21 counties
- MyAdvocate Medicare Advantage SILVER (HMO-POS) — Offered in NE: 21 counties
Presbyterian Health Plan
1 plan on this site
- Presbyterian Dual Plus (HMO D-SNP) — Offered in NM: 20 counties
PrimeTime Health Plan
3 plans on this site
- PrimeTime Health Plan Aultimate (HMO-POS) — Offered in OH: Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Wayne
- PrimeTime Health Plan Classic (HMO-POS) — Offered in OH: Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Wayne
- PrimeTime Health Plan Plus (HMO-POS) — Offered in OH: Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Wayne
Prominence Health Plan
11 plans on this site
- Prominence Beyond (HMO-POS) — Offered in TX: Cooke, Deaf Smith, Fannin, Gray, Grayson, Moore, Potter, Randall
- Prominence Bridge (HMO D-SNP) — Offered in TX: Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy, Zapata
- Prominence Diabetes and Heart (HMO C-SNP) — Offered in NV: Washoe
- Prominence Diabetes and Heart Care Plus (HMO C-SNP) — Offered in TX: Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy, Zapata
- Prominence Diabetes and Heart Giveback (HMO C-SNP) — Offered in TX: Cooke, Deaf Smith, Fannin, Gray, Grayson, Moore, Potter, Randall
- Prominence Dual (HMO D-SNP) — Offered in TX: Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy, Zapata
- Prominence Extra Help (HMO) — Offered in TX: Brooks, Cameron, Hidalgo, Jim Hogg, Starr, Webb, Willacy, Zapata
- Prominence Giveback (HMO) — Offered in TX: Cooke, Deaf Smith, Fannin, Gray, Grayson, Moore, Potter, Randall
- Prominence Meridian (HMO-POS) — Offered in NV: Washoe
- Prominence Plus (HMO) — Offered in TX: Cooke, Deaf Smith, Fannin, Gray, Grayson, Moore, Potter, Randall
- Prominence Silver Peak (HMO) — Offered in NV: Carson City, Churchill, Douglas, Lyon, Storey
Quartz Medicare Advantage (HMO)
14 plans on this site
- Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
- Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
- Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
- Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
- Gundersen Quartz Med Advantage Basic D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
- Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
- Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) — Offered in WI: La Crosse
- Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
- Gundersen Quartz Med Advantage Value D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
- UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
- UW Health Quartz Med Advantage Core D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
- UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) — Offered in WI: Dane
- UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
- UW Health Quartz Med Advantage Value D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
Samaritan Advantage Health Plans
1 plan on this site
- Samaritan Dual Advantage (HMO D-SNP) — Offered in OR: Benton, Lincoln, Linn
Security Health Plan of Wisconsin, Inc.
4 plans on this site
- Esteem Rx (HMO) — Offered in WI: 33 counties
- Esteem Rx Gold (HMO-POS) — Offered in WI: 33 counties
- Esteem Rx Silver (HMO-POS) — Offered in WI: 33 counties
- Legacy Rx (HMO-POS) — Offered in WI: 33 counties
Simply Healthcare Plans, Inc.
2 plans on this site
- Simply Complete Platinum (HMO D-SNP) — Offered in FL: 24 counties
- Simply Integrated Platinum (HMO D-SNP) — Offered in FL: 24 counties
South Country Health Alliance
2 plans on this site
- AbilityCare (HMO D-SNP) — Offered in MN: Brown, Dodge, Goodhue, Sibley, Steele, Wabasha, Waseca
- SeniorCare Complete (HMO D-SNP) — Offered in MN: Brown, Dodge, Goodhue, Sibley, Steele, Wabasha, Waseca
Tufts Health Plan
6 plans on this site
- Tufts Medicare Preferred HMO Basic Rx (HMO) — Offered in MA: Barnstable, Bristol, Middlesex, Norfolk, Plymouth
- Tufts Medicare Preferred HMO Prime Rx (HMO) — Offered in MA: Barnstable, Bristol, Middlesex, Norfolk, Plymouth
- Tufts Medicare Preferred HMO Prime Rx Plus (HMO) — Offered in MA: Barnstable, Bristol, Middlesex, Norfolk, Plymouth
- Tufts Medicare Preferred HMO Smart Saver Rx (HMO) — Offered in MA: Bristol, Essex, Norfolk, Plymouth, Suffolk
- Tufts Medicare Preferred HMO Value Rx (HMO) — Offered in MA: Barnstable, Bristol, Middlesex, Norfolk, Plymouth
- Tufts Medicare Preferred PPO RX (PPO) — Offered in MA: Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
Ultimate Health Plans
5 plans on this site
- Advantage Care COPD by Ultimate (HMO C-SNP) — Offered in FL: 12 counties
- Advantage Care by Ultimate (HMO C-SNP) — Offered in FL: Citrus, Hernando, Pasco
- Advantage Plus by Ultimate (Full) (HMO D-SNP) — Offered in FL: 16 counties
- Advantage Plus by Ultimate (Partial) (HMO D-SNP) — Offered in FL: 16 counties
- Premier by Ultimate (HMO) — Offered in FL: Citrus, Hernando, Indian River, Pasco, St. Lucie
VISTA Health Plan Inc.
2 plans on this site
- Amerihealth Caritas VIP Care (HMO D-SNP) — Offered in PA: 62 counties
- Keystone First VIP Choice (HMO D-SNP) — Offered in PA: Bucks, Chester, Delaware, Montgomery, Philadelphia
Wellpoint
30 plans on this site
- Wellpoint Chronic Care (HMO-POS C-SNP) — Offered in TX: 11 counties
- Wellpoint Chronic Care 2 (HMO-POS C-SNP) — Offered in AZ: Pima
- Wellpoint Chronic Care Advantage (HMO C-SNP) — Offered in TX: El Paso, Hidalgo
- Wellpoint Chronic Care Advantage Select (HMO C-SNP) — Offered in TX: Bexar, Dallas, Harris
- Wellpoint Chronic Care Select (HMO-POS C-SNP) — Offered in TX: Bexar, Dallas, Fort Bend, Harris, Tarrant
- Wellpoint Dual Advantage (HMO D-SNP) — Offered in TX: 99 counties
- Wellpoint Dual Advantage Plus (HMO D-SNP) — Offered in TX: 99 counties
- Wellpoint Dual Advantage Plus Select (HMO D-SNP) — Offered in TX: Dallas, Fort Bend, Harris, Tarrant
- Wellpoint Dual Advantage Select (HMO D-SNP) — Offered in TX: Bexar, Dallas, Fort Bend, Harris, Tarrant
- Wellpoint Extra Help (HMO) — Offered in NJ: Bergen, Camden, Essex, Hudson, Middlesex, Morris, Passaic, Union
- Wellpoint Extra Help (HMO-POS) — Offered in TN: 95 counties
- Wellpoint Full Dual Advantage (HMO D-SNP) — Offered in TX: 63 counties
- Wellpoint Full Dual Advantage (HMO-POS D-SNP) — Offered in IA: 99 counties
- Wellpoint Full Dual Advantage 2 (HMO D-SNP) — Offered in TN: 95 counties
- Wellpoint Full Dual Advantage Aligned (HMO D-SNP) — Offered in TX: 99 counties
- Wellpoint Full Dual Advantage Select (HMO D-SNP) — Offered in TX: Fort Bend, Tarrant
- Wellpoint Full Dual Advantage Support (HMO D-SNP) — Offered in TN: 95 counties
- Wellpoint I CareMore Home Care (HMO I-SNP) — Offered in AZ: Maricopa, Pima
- Wellpoint I CareMore Home Care 2 (HMO I-SNP) — Offered in AZ: Maricopa, Pima
- Wellpoint I CareMore Kidney Care (HMO-POS C-SNP) — Offered in AZ: Pima
- Wellpoint Kidney Care (HMO-POS C-SNP) — Offered in TX: 56 counties
- Wellpoint Lung Care (HMO-POS C-SNP) — Offered in AZ: Maricopa, Pima
- Wellpoint Lung Care 2 (HMO-POS C-SNP) — Offered in AZ: Pima
- Wellpoint Lung Care Select (HMO-POS C-SNP) — Offered in TX: Harris
- Wellpoint Medicare Advantage (HMO-POS) — Offered in TN: 95 counties
- Wellpoint Medicare Advantage 1 (HMO-POS) — Offered in AZ: Pima
- Wellpoint Medicare Advantage 2 (HMO-POS) — Offered in TX: 83 counties
- Wellpoint Medicare Advantage Select (HMO-POS) — Offered in TX: Dallas, Tarrant
- Wellpoint Medicare Advantage Select 1 (HMO-POS) — Offered in TX: Fort Bend, Harris, Montgomery
- Wellpoint Premium Savings (HMO-POS) — Offered in AZ: Pima
eternalHealth
6 plans on this site
- eternalHealth Catalina (HMO) — Offered in AZ: Pima
- eternalHealth Forever (HMO) — Offered in MA: Bristol, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
- eternalHealth Freedom (PPO) — Offered in MA: Bristol, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
- eternalHealth Give Back (PPO) — Offered in MA: Bristol, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
- eternalHealth Harmony (HMO) — Offered in AZ: Graham, Maricopa, Pinal
- eternalHealth Horizon (HMO) — Offered in AZ: Graham, Maricopa, Pima, Pinal
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage.
Source: CMS Prescription Drug Plan Formulary data + this site's published plan records · List built 2026-11-08