Links to Summaries by State for LTC Drugs on LIS/SNP Plans:
Drug Name![]() |
Packaging | NDC | On This Nbr of 2021 Formularies | |
PDPs | MAPDs | |||
JASMIEL 3 MG-0.02 MG TABLET [Yaz] (Drospirenone, Ethinyl Estradiol;Inert) |
28 TABLETs | 50102024023 | 65 PDPs |
353 MAPDs |
LORYNA 3 MG-0.02 MG TABLET [Yaz] (Drospirenone, Ethinyl Estradiol;Inert) |
28 tablets | 70700011485 | 63 PDPs |
358 MAPDs |
NIKKI 3 MG-0.02 MG TABLET [Yaz] (Drospirenone, Ethinyl Estradiol;Inert) |
28 TABLETS | 68180088673 | 62 PDPs |
356 MAPDs |
YASMIN 28 3-0.03MG TABLET (Drospirenone-Ethinyl Estradiol) |
21 YELLOW + 7 WHITE X 3 BOX | 50419040203 | 3 PDPs |
28 MAPDs |
YAZ 3-0.02MG TABLET (Drospirenone-Ethinyl Estradiol) |
24 X 3 BOX | 50419040503 | 4 PDPs |
22 MAPDs |
YF-VAX 1 DOSE VIAL/DILUENT 0.5UNTS/DOSE (Yellow Fever Vaccine Subcutaneous) |
1 DOSE WITH DILUENT X 5 VIAL | 49281091501 | 70 PDPs |
389 MAPDs |
YONSA 125 MG TABLET (Abiraterone) |
tablets | 47335040181 | 14 PDPs |
178 MAPDs |
YUPELRI 175 MCG/3 ML SOLUTION VIAL-NEB (Revefenacin) |
90 mls | 49502080632 | 3 PDPs |
47 MAPDs |
YUVAFEM 10 MCG VAGINAL INSERT (Estradiol) |
8.000 EA | 65162022621 | 58 PDPs |
318 MAPDs |