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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
RDA-Preg Tabs Basic Prenatal Multivitamins & Minerals W/Iron & Fa Tab 0.8 Mg 710638001 Prenatal Vitamins
RDA-Preg Tabs Core *Prenatal Multivitamins & Minerals w/iron & FA 0.8 MG*** 710638001 Prenatal Vitamins
RDA-Preg Tabs Standard *Prenatal Multivitamins & Minerals w/iron & FA Tab 0.8 MG*** 710638001 Prenatal Vitamins
Rda-Preg Tabs Extended Prenatal Multivitamins & Minerals W/Iron & Fa Tab 0.8 Mg 710638001 Prenatal Vitamins
Remedica Folic Acid Extended Folic Acid Tab 5 Mg 967951001 Prenatal Vitamins
Remedica Folic Acid Bots Basic Folic Acid Tab 5 Mg 967951001 Prenata Vitamins
Remedica Folic Acid Bots Standard Folic Acid Tab 5 MG 967951001 Prenatal Vitamins
Revite Calcium + Vit D Ca Basic *Calcium 350 Mg W/ Vitamin D Cap*** 841013004 Mineral Combination
Revite Calcium + Vit D CA Standard *Calcium 350 MG W/Vitamin D Cap*** 841013004 Mineral Combinations
Revite Calcium + Vit D Ca Extended Calcium 350 Mg W/ Vitamin D Cap 841013004 Mineral Combinations
Sc Folacin(Floic Acid) Ta Basic Folic Acid Tab 400 Mcg 703593006 Prenatal Vitamins
Scriptsavers Expecta Caps Extended Prenatal Vitamin Cap 715130001 Prenatal Vitamins
ScriptSavers Expecta Caps Basic Prenatal Vitamin Cap 715130001 Prenatal Vitamins
Scriptsavers Expecta Caps Core *Prenatal Vitamins Cap** 715130001 Prenatal Vitamins
Scriptsavers Expecta Caps Standard *Prenatal Vitamin Cap** 715130001 Prenatal Vitamins
SHS Folic Acid 0.8MG Tabs Core Folic Acid Tab 800 MCG 713877001 Prenatal Vitamins
Shs Folic Acid 0.8Mg Tabs Extended Folic Acid Tab 800 Mcg 713877001 Prenatal Vitamins
SHS Folic Acid 0.8Mg Tabs Basic Folic Acid Tab 800 Mcg 713877001 Prenatal Vitamins
SHS Folic Acid 0.8MG Tabs Standard Folic Acid Tab 800 MCG 713877001 Prenatal Vitamins
Solal Folate 500Mcg Tabs Extended Folic Acid Tab 0.5 Mg 723361001 Prenatal Vitamins
Solal Folate 500Mcg Tabs Basic Folic Acid Tab 0.5 Mg 723361001 Prenatal Vitamins
Solal Folate 500MCG Tabs Standard Folic Acid Tab 0.5 MG 723361001 Prenatal Vitamins
Solal Folate 500MCG Tabs Core Folic Acid Tab 0.5 MG 723361001 Prenatal Vitamins
Stella-Mama 30 Day Pack Extended Prenatal W/Fe-Ca Tab & Omega 3 Cap Pack 722209001 Prenatal Vitamins
Stellar Activ-Folate 500M Extended Folic Acid Tab 0.5 Mg 723196001 Prenatal Vitamins
Stellar Activ-Folate 500M Extended Folic Acid Tab 0.5 Mg 723196002 Prenatal Vitamins
Stellar Activ-Folate 500M Basic Folic Acid Tab 0.5 Mg 723196002 Prenatal Vitamins
Stellar Activ-Folate 500M Standard Folic Acid Tab 0.5 MG 723196001 Prenatal Vitamins
Stellar Activ-Folate 500M Standard Folic Acid Tab 0.5 MG 723196002 Prenatal Vitamins
Stellar Activ-Folate 500M Core Folic Acid Tab 0.5 MG 723196001 Prenatal Vitamins
Stellar Activ-Folate 500M Core Folic Acid Tab 0.5 MG 723196002 Prenatal Vitamins
Stellr Activ-Folate 500M Basic Folic Acid Tab 0.5 Mg 723196001 Prenatal Vitamins
Suplimax Folic Acid Nam O Extended Folic Acid Cap 5 Mg 722988001 Prenatal Vitamins
Suplimax Folic Acid Nam O Basic Folic Acid Cap 5 Mg 722988001 Prenatal Vitamins
Suplimax Folic Acid Nam O Standard Folic Acid Cap 5 MG 722988001 Prenatal Vitamins
Suplimax Folic Acid Nam O Core Folic Acid Cap 5 MG 722988001 Prenatal Vitamins
Supracal 500Mg Tabs Basic Calcium Carbonate-Vitamin D Tab 1250 Mg-400 Unit 793523001 Mineral Combinations
Supracal 500Mg Tabs Extended Calcium Carbonate-Vitamin D Tab 1250 Mg-400 Unit 793523001 Mineral Combinations
Supravit Active Preg Caps Extended Prenatal Vitamin Cap 721111001 Prenatal Vitamins
Supravit Active Preg Caps Basic Prenatal Vitamin Cap 721111001 Prenatal Vitamins
Supravit Active Preg Caps Core *Prenatal Vitamins Cap** 721111001 Prenatal Vitamins
Supravit Active Preg Caps Standard *Prenatal Vitamin Cap** 721111001 Prenatal Vitamins
Supreme Pregnancy Booster Extended Prenatal Vitamin Cap 704433001 Prenatal Vitamins
Supreme Pregnancy Booster Basic Prenatal Vitamin Cap 704433001 Prenatal Vitamins
Supreme Pregnancy Booster Core *Prenatal Vitamins Cap** 704433001 Prenatal Vitamins
Supreme Pregnancy Booster Standard *Prenatal Vitamin Cap** 704433001 Prenatal Vitamins
Surpacal 500MG Tabs Standard Calcium carbonate-Vitamin D Tab 1250 MG-400 Unit 793523001 Mineral Combinations
SV Folacin (Folic Acid) TA Core Folic Acid Tab 800 MCG 703594007 Prenatal Vitamins
SV Folacin (Folic Acid) TA Core Folic Acid Tab 400 MCG 703593003 Prenatal Vitamins
SV Folacin (Folic Acid) TA Core Folic Acid Tab 400 MCG 703593006 Prenatal Vitamins

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