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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
Folic Acid 0.5MG Tabs Core Folic Acid Tab 0.5 MG 721366001 Prenatal Vitamins
Folic Acid 500Cg Caps Basic Folic Acid Cap 500 Mcg 723151001 Prenatal Vitamins
Folic Acid 500Mcg Caps Extended Folic Acid Cap 500 Mcg 723151001 Prenatal Vitamins
Folic Acid 500MCG Caps Standard Folic Acid Cap 500 MCG 723151001 Prenatal Vitamins
Folic Acid 500MCG Caps Core Folic Acid Cap 500 MCG 723151001 Prenatal Vitamins
Folic Acid 5Mg Extended Folic Acid Cap 5 Mg 702348003 Prenatal Vitamins
Folic Acid 5Mg Basic Folic Acid Cap 5 Mg 702348003 Prenatal Vitamins
Folic Acid 5MG Standard Folic Acid Cap 5 MG 702348003 Prenatal Vitamins
Folic Acid 5MG Core Folic Acid Cap 5 MG 702348003 Prenatal Vitamins
Folic Acid Bots 5MG Tabs Core Folic Acid Tab 5 MG 967395001 Prenatal Vitamins
Folic Acid Bots 5Mg Tabs Extended Folic Acid Tab 5 Mg 967395001 Prenatal Vitamins
Folic Acid Bots 5Mg Tabs Basic Folic Acid Tab 5 Mg 967395001 Prenatal Vitamins
Folic Acid Bots 5MG Tabs Standard Folic Acid Tab 5 MG 967395001 Prenatal Vitamins
Folic Acid Bots Only 5MG Core Folic Acid Tab 5 MG 967038001 Prenatal Vitamins
Folic Acid Bots Only 5MG Core Folic Acid Tab 5 MG 967038002 Prenatal Vitamins
Folic Acid Bots Only 5Mg Extended Folic Acid Tab 5 Mg 967038001 Prenatal Vitamins
Folic Acid Bots Only 5Mg Extended Folic Acid Tab 5 Mg 967038002 Prenatal Vitamins
Folic Acid Bots Only 5Mg Basic Folic Acid Tab 5 Mg 967038001 Prenatal Vitamins
Folic Acid Bots Only 5Mg Basic Folic Acid Tabs 5 Mg 967038002 Prenatal Vitamins
Folic Acid Bots Only 5MG Standard Folic Acid Tab 5 MG 967038001 Prenatal Vitamins
Folic Acid Bots Only 5MG Standard Folic Acid Tab 5 MG 967038002 Prenatal Vitamins
Folic Acid Max 400Mcg Tab Extended Folic Acid Tab 400 Mcg 721094001 Prenatal Vitamins
Folic Acid Max 400Mcg Tab Basic Folic Acid Tab 400 Mcg 721094001 Prenatal Vitamins
Folic Acid Max 400MCG Tab Standard Folic Acid Tab 400 MCG 721094001 Prenatal Vitamins
Folic Acid Max 400MCG Tab Core Folic Acid Tab 400 MCG 721094001 Prenatal Vitamins
Folic Select 800MCG/25MCG Core Folic Acid Tab 800 MCG 710915001 Prenatal Vitamins
Folic Select 800Mcg/25Mcg Extended Folic Acid Tab 800 Mg 710915001 Prenatal Vitamins
Folic Select 800Mcg/25Mcg Basic Folic Acid Tab 800 Mcg 710915001 Prenatal Vitamins
Folic Select 800MCG/25MCG Standard Folic Acid Tab 800 MCG 710915001 Prenatal Vitamins
Folik 0.5Mg Tabs Extended Folic Acid Tab 0.5 Mg 721661001 Prenatal Vitamins
Folik 0.5Mg Tabs Basic Folic Acid Tab 0.5 Mg 721661001 Prenatal Vitamins
Folik 0.5MG Tabs Standard Folic Acid Tab 0.5 MG 721661001 Prenatal Vitamins
Folik 0.5MG Tabs Core Folic Acid Tab 0.5 MG 721661001 Prenatal Vitamins
Fs Pregnancy Form Basic *Prenatal Multivitamins & Minerals W/ Iron Tab*** 704200001 Prenatal Vitamins
FS Pregnancy Form Standard *Prenatal Multivitamins & Minerals w/iron Tab*** 704200001 Prenatal Vitamins