Subpage banner

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
Pregnatal Nam Only Tabs Extended Prenatal Vitamin Cap 3000292001 Prenatal Vitamins
Pregnatal Nam Only Tabs Basic Prenatal Vitamin Tab 3000292001 Prenatal Vitamins
Pregnatal Nam Only Tabs Core *Prenatal Vitamins Tab** 3000292001 Prenatal Vitamins
Pregnatal Nam Only Tabs Standard *Prenatal Vitamin Tab** 3000292001 Prenatal Vitamins
Pregnavit M Caps Extended Prenatal Vit W/ Fe Fumarate-Fa Cap 60-0.8 Mg 834890003 Prenatal Vitamins
Pregnavit M Caps Extended Prenatal Vit W/ Fe Fumarate-Fa Cap 60-0.8 Mg 834890005 Prenatal Vitamins
Pregnavit M Caps Standard *Prenatal Vit w/fe Fumarate-FA Tab 60-0.8 MG*** 834890003 Prenatal Vitamins
Pregnavit M Caps Standard *Prenatal Vit w/fe Fumarate-FA Tab 60-0.8 MG*** 834890005 Prenatal Vitamins
Pregomega Plus Day Pack Extended Prenatal W/Fe-Ca Tab & Omega 3 Cap Pack 713755001 Prenatal Vitamins
Pregs Vitamin & Mineral Sup Extended Prenatal Vitamin Cap 704602001 Prenatal Vitamins
Pregs Vitamin & Mineral Sup Core *Prenatal Vitamins Cap** 704602001 Prenatal Vitamins
Pregs Vitamin&Mineral Sup Basic Prenatal Vitamin Cap 704602001 Prenatal Vitamins
Pregs Vitamin&Mineral Sup Standard *Prenatal Vitamin Cap** 704602001 Prenatal Vitamins
Pregvit Mr Tabs Standard *Prenatal Multivitamins & Minerals w/iron & FA Tab 0.5 MG*** 893038005 Prenatal Vitamins
Pregvit Mr Tabs Extended Prenatal Multivitamins & Minerals W/Iron & Fa Tab 0.5 Mg 893038005 Prenatal Vitamins
Pregwise Tabs Extended Prenatal Vitamin Cap 716965001 Prenatal Vitamins
Pregwise Tabs Extended Prenatal Vitamin Cap 716965002 Prenatal Vitamins
Pregwise Tabs Basic Prenatal Vitamin Tab 716965001 Prenatal Vitamins
Pregwise Tabs Basic Prenatal Vitamin Tab 716965002 Prenatal Vitamins
Pregwise Tabs Core *Prenatal Vitamins Tab** 716965001 Prenatal Vitamins
Pregwise Tabs Core *Prenatal Vitamins Tab** 716965002 Prenatal Vitamins
Pregwise Tabs Standard *Prenatal Vitamin Tab** 716965001 Prenatal Vitamins
Pregwise Tabs Standard *Prenatal Vitamin Tab** 716965002 Prenatal Vitamins
Prenatal Vitamin Caps Basic Prenatal Vitamin Cap 3002857001 Prenatal Vitamins
Preomega Day Pack Extended Prenatal W/Fe-Ca Tab & Omega 3 Cap Pack 710721001 Prenatal Vitamins
Pronatal Tabs Extended Prenatal Vitamin Cap 3003685001 Prenatal Vitamins
Pronatal Tabs Basic Prenatal Vitamin Tab 3003685001 Prenatal Vitamins
Pronatal Tabs Core *Prenatal Vitamins Tab** 3003685001 Prenatal Vitamins
Pronatal Tabs Standard *Prenatal Vitamin Tab** 3003685001 Prenatal Vitamins
Puritans Flic Acid 800 T Core Folic Acid Tab 800 MCG 706351001 Prenatal Vitamins
Puritans Folic Acid 800 C Extended Folic Acid Cap 0.8 Mg 706352001 Prenatal Vitamins
Puritans Folic Acid 800 C Basic Folic Acid Cap 0.8 Mg 706352001 Prenatal Vitamins
Puritans Folic Acid 800 C Core Folic Acid Cap 0.8 MG 706352001 Prenatal Vitamins
Puritans Folic Acid 800 C Standard Folic Acid Cap 0.8 MG 706352001 Prenatal Vitamins
Puritans Folic Acid 800 T Extended Folic Acid Tab 800 Mcg 706351001 Prenatal Vitamins
Puritans Folic Acid 800 T Basic Folic Acid Tab 800 Mcg 706351001 Prenatal Vitamins
Puritans Folic Acid 800 T Standard Folic Acid Tab 800 MCG 706351001 Prenatal Vitamins
Puritans Prenatal Complex Extended Prenatal Vitamin Cap 707051001 Prenatal Vitamins
Puritans Prenatal Complex Basic Prenatal Vitamin Cap 707051001 Prenatal Vitamins
Puritans Prenatal Complex Standard *Prenatal Vitamin Cap** 707051001 Prenatal Vitamins
Puritans Prenatal Complex Core *Prenatal Vitamins Cap** 707051001 Prenatal Vitamins
Puritans Prenatal Complex Core *Prenatal Vitamins Cap** 707051001 Prenatal Vitamins
Puritans Prenatal Vitamin Extended Prenatal Vitamin Tab 707079001 Prenatal Vitamins
Puritans Prenatal Vitamin Basic Prenatal Vitamin Tab 707079001 Prenatal Vitamins
Puritans Prenatal Vitamin Core *Prenatal Vitamins Tab** 707079001 Prenatal Vitamins
Puritans Prenatal Vitamin Standard *Prenatal Vitamin Tab** 707079001 Prenatal Vitamins
Quadfolic 0.5Mg Tabs Extended Folic Acid Tab 0.5 Mg 3000090001 Prenatal Vitamins
Quadfolic 0.5Mg Tabs Basic Folic Acid Tab 0.5 Mg 3000090001 Prenatal Vitamins
Quadfolic 0.5mg Tabs Standard Folic Acid Tab 0.5 MG 3000090001 Prenatal Vitamins
Quadfolic 0.5mg Tabs Core Folic Acid Tab 0.5 MG 3000090001 Prenatal Vitamins