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Formulary List

Explore our comprehensive list of medications covered under your health plan. This list currently shows pre-natal formularies to support our patient’s well-being. All Core health plans use the Pregnancy Core formulary, All Plus health plans use the Pregnancy Basic, All Extra health plans use the Pregnancy Standard and All Max health plans use the Pregnancy Extended. Review this page regularly to stay informed.
Drug Name9 Months + Calcium & Omega
Active Ingredient
Prenatal W/Fe-Fa Tab & Omega 3 Cap Pack
NAPPI Code
723620001
Therapeutic Group
Prenatal Vitamins
Drug Name Formulary Active Ingredient NAPPI Code Therapeutic Group
Holistix Total Supply Pre Core *Prenatal Vitamins Cap** 716535002 Prenatal Vitamins
Holistix Total Supply Pre Standard *Prenatal Vitamin Cap** 716535001 Prenatal Vitamins
Holistix Total Supply Pre Standard *Prenatal Vitamin Cap** 716535002 Prenatal Vitamins
Holistix Total Supply Pre Standard *Prenatal Vitamin Cap** 716535003 Prenatal Vitamins
Holistix Total Suppy Pre Extended Prenatal Vitamin Cap 716535001 Prenatal Vitamins
Medirite Pregnancy Supple Extended Prenatal W/Fe-Fa-Ca Tab & Omega 3 Cap Pack 3003969001 Prenatal Vitamins
MI-Vitamin Pregnancy Caps Extended Prenatal Vit W/ Fe Fumarate-Fa Cap 60-0.8 Mg 3002813001 Prenatal Vitamins
MI-Vitamin Pregnancy Caps Standard *Prenatal Vit w/fe Fumarate-FA Tab 60-0.8 MG*** 3002813001 Prenatal Vitamins
MVA Preg 1st Tri Nam Only Extended Prenatal W/Fe-Fa-Ca Tab & Omega 3 Cap Pack 3003851001 Prenatal Vitamins
MVA Preg-O Plus Nam Only Extended Prenatal W/Fe-Fa-Ca Tab & Omega 3 Cap Pack 3001791001 Prenatal Vitamins
Nikibon Caps Extended Prenatal Vit W/ Fe Fumarate-Fa Cap 30-0.8 Mg 894052004 Prenatal Vitamins
Nikibon Caps Basic Prenatal Vit W/ Fe Fumarate-Fa Cap 30-0.8 Mg 894052004 Prenatal Vitamins
Nikibon Caps Core *Prenatal Vit & Minerals w/fe Fumarate-FA Cap 30-0.8 MG*** 894052004 Prenatal Vitamins
Nikibon Caps Standard *Prenatal Vit w/fe Fumarate-FA Cap 30-0.8 MG*** 894052004 Prenatal Vitamins
Nordic Prenatal Dha SoftG Extended Prenatal Vit W/ Fe Fumarate-Fa Cap 60-0.8 Mg 719743001 Prenatal Vitamins
Nordic Prenatal DHA Softg Standard *Prenatal Vit w/fe Fumarate-FA Tab 60-0.8 MG*** 719743001 Prenatal Vitamins
Nutrissentials Expectant Extended Prenatal Multivitamins & Minerals W/Iron & Fa Cap 0.8 Mg 711815001 Prenatal Vitamins
Omiage (30 Caps + 30 Tabs) Extended Prenatal W/Fe-Fa-Ca Tab & Omega 3 Cap Pack 716302001 Prenatal Vitamins
Pc Calcium 500Mg Eff Tabs Basic Calcium Carbonate Effer Tab 1250 Mg 715192001 Calcium
PC Calcium 500MG EFF Tabs Standard Calcium Carbonate Effer Tab 1250 MG 715192001 Calcium
Pc Calcium 500Mg Eff Tabs Extended Calcium Carbonate Effer Tab 1250 Mg 715192001 Calcium
Pre-Natal Caps Standard *Prenatal Multivitamins 7 Minerals w/iron & FA Cap 1 MG*** 701693001 Prenatal Vitamins
Pre-Natal Vitamin Caps Extended Prenatal Vitamin Cap 3002857001 Prenatal Vitamins
Pre-Natal Vitamin Caps Core *Prenatal Vitamins Cap** 3002857001 Prenatal Vitamins
Pre-Natal Vitamin Caps Standard *Prenatal Vitamin Cap** 3002857001 Prenatal Vitamins
Preg O Mum Complete Kit Extended Prenatal W/Fe-Ca Tab & Omega 3 Cap Pack 723579001 Prenatal Vitamins
Preg Quadfolic 0.5Mg Tabs Extended Folic Acid Tab 0.5 Mg 3000074001 Prenatal Vitamins
Preg QuadFolic 0.5Mg Tabs Basic Folic Acid Tab 0.5 Mg 3000074001 Prenatal Vitamins
Preg Quadfolic 0.5mg Tabs Standard Folic Acid Tab 0.5 MG 3000074001 Prenatal Vitamins
Preg Quadfolic 0.5mg Tabs Core Folic Acid Cap 0.5 MG 3000074001 Prenatal Vitamins
Preg Vit Caps Extended Prenatal Multivitamins & Minerals W/Iron & Fa Cap 0.8 Mg 723675001 Prenatal Vitamins
Preg-Natal Caps Basic *Prenatal Multivitamins & Minerals W/ Iron & Fa Cap 1 Mg*** 701693001 Prenatal Vitamins
Preg-Natal Caps Extended Prenatal Multivitamins & Minerals W/Iron & Fa Cap 1 Mg 701693001 Prenatal Vitamins
Preg-Well Caps Extended Prenatal Vitamin Cap 707327001 Prenatal Vitamins
Preg-Well Caps Basic Prenatal Vitamin Cap 707327001 Prenatal Vitamins
Preg-Well Caps Core *Prenatal Vitamins Cap** 707327001 Prenatal Vitamins
Preg-Well Caps Standard *Prenatal Vitamin Cap** 707327001 Prenatal Vitamins
Preggy-Mama Tabs Standard *Prenatal Multivitamins & Minerals w/iron & FA Tab 0.5 MG*** 722210001 Prenatal Vitamins
Preggy-Mama Tabs Extended Prenatal Multivitamins & Minerals W/Iron & Fa Cap 0.5 Mg 722210001 Prenatal Vitamins
Pregi Forte Caps Extended Prenatal Vitamin Cap 715465001 Prenatal Vitamins
Pregi Forte Caps Extended Prenatal Vitamin Cap 3000364001 Prenatal Vitamins
Pregi Forte Caps Basic Prenatal Vitamin Cap 715465001 Prenatal Vitamins
Pregi Forte Caps Core *Prenatal Vitamins Cap** 715465001 Prenatal Vitamins
Pregi Forte Caps Standard *Prenatal Vitamin Cap** 715465001 Prenatal Vitamins
Pregnacare Plu 28 Tablet Extended Prenatal W/Fe-Ca Tab & Omega 3 Cap Pack 714323001 Prenatal Vitamins
Pregnacare Tabs Standard *Prenatal Multivitamins & Minerals w/iron & FA Tab 0.5 MG*** 711697001 Prenatal Vitamins
Pregnacare Tabs Extended Prenatal Multivitamins & Minerals W/Iron & Fa Tab 0.5 Mg 711697001 Prenatal Vitamins
Pregnapil Plus Caps Basic Prenatal Vitamin Cap 3000364001 Prenatal Vitamins
Pregnapil Plus Caps Core *Prenatal Vitamins Cap** 3000364001 Prenatal Vitamins
Pregnapil Plus Caps Standard *Prenatal Vitamin Cap** 3000364001 Prenatal Vitamins

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