Information for Vermont Prescribers of Prescription Drugs (Long Form) Natazia (Estradiol Valerate-Dienogest) This list does not imply that the products on this chart are interchangeable or have the same efficacy or safety. Please refer to each product s FDA-approved label and indication for further information. The prices listed below are Average Wholesale s ("AWP") as established and made available to the public by a third party publisher or as calculated from data made available to the public by a third party publisher. The price paid by consumers may be higher or lower than the prices listed below. Information about AWP of these drugs is being provided to Vermont prescribers pursuant to Vermont law, to give you information about the relative prices of marketed drugs and other drugs in the same therapeutic class. The prices listed here do not necessarily reflect price per dosage, price per course of treatment, or the cost effectiveness of all the products listed. For simplicity, only the smallest package sizes available for each product are included. Marketed Product: Product Name Manufacturer NDC Natazia Oral Tablet 3/2-2/2-3/1 Other Products: Pkg Size Product Name Manufacturer NDC Size Altavera Oral Tablet 0.15-30 - Alyacen 1/35 Oral Tablet 1-35 Alyacen 7/7/7 Oral Tablet 0.5/0.75/1-35 Amethia Lo Oral Tablet 0.1-0.02 & 0.01 Amethia Oral Tablet 0.15-0.03 &0.01 50419040901 28 $123.85 $4.42 SANDOZ 00781558307 28 $30.92 $1.10 68462039429 28 $93.10 $1.11 68462055629 28 $101.50 $1.21 ACTAVIS 52544022891 91 $268.55 $2.95 ACTAVIS 52544026884 91 $268.55 $2.95 Amethyst Oral Tablet 90-20 ACTAVIS 52544029528 28 $59.40 $2.12 Apri Oral Tablet 0.15-30 - Aranelle Oral Tablet 0.5/1/0.5-35 Aubra Oral Tablet 0.1-20 - Aviane Oral Tablet 0.1-20 - Azurette Oral Tablet 0.15-0.02/0.01 (21/5) Balziva Oral Tablet 0.4-35 - 1 00555904358 28 $183.10 $1.09 00555906667 28 $118.05 $1.41 AFAXYS 50102012001 28 $13.60 $0.49 00555904558 28 $210.96 $1.26 ACTAVIS 52544094028 28 $359.88 $2.14 00555903458 28 $269.01 $1.60
Beyaz Oral Tablet 3-0.02-0.451 Brevicon (28) Oral Tablet 0.5-35 Briellyn Oral Tablet 0.4-35 - Camila Oral Tablet 0.35 Camrese Lo Oral Tablet 0.1-0.02 & 0.01 Camrese Oral Tablet 0.15-0.03 &0.01 Caziant Oral Tablet 0.1/0.125/0.15-0.025 Cesia Oral Tablet 0.1/0.125/0.15-0.025 Chateal Oral Tablet 0.15-30 - Cryselle-28 Oral Tablet 0.3-30 Cryselle-28 Oral Tablet 0.3-30 Cyclafem 1/35 Oral Tablet 1-35 Cyclafem 7/7/7 Oral Tablet 0.5/0.75/1-35 Cyclessa Oral Tablet 0.1/0.125/0.15-0.025 Dasetta 1/35 Oral Tablet 1-35 Dasetta 7/7/7 Oral Tablet 0.5/0.75/1-35 Daysee Oral Tablet 0.15-0.03 &0.01 Desogen Oral Tablet 0.15-30 - Desogestrel-Ethinyl Estradiol Oral Tablet 0.15-30 Drospirenone-Ethinyl Estradiol Oral Tablet 3-0.03 Elinest Oral Tablet 0.3-30 - 50419040701 28 $123.85 $4.42 ACTAVIS 52544025428 28 $223.82 $2.66 68462031629 28 $134.50 $1.60 00555071558 28 $221.49 $1.32 00093614882 91 $537.10 $2.95 00093313491 91 $268.55 $2.95 ACTAVIS 52544095931 28 $100.93 $1.20 PRASCO LABORATORIES 66993061528 28 $99.99 $1.19 AFAXYS 50102013001 28 $16.63 $0.59 00555904958 28 $183.12 $1.09 TEVA/WOMENS HEALTH 51285054628 28 $183.12 $1.09 QUALITEST 00603752149 28 $93.11 $1.11 QUALITEST 00603752549 28 $101.73 $1.21 ORGANON 00052028306 28 $392.02 $2.33 NORTHSTAR RX 16714034801 28 $29.49 $1.05 NORTHSTAR RX 16714034601 28 $32.22 $1.15 68180084611 91 $268.55 $2.95 ORGANON 00052026106 28 $343.10 $2.04 NORTHSTAR RX 16714036701 28 $36.39 $1.30 68180090211 28 $76.68 $2.74 NORTHSTAR RX 16714036501 28 $30.52 $1.09 Ella Oral Tablet 30 AFAXYS 50102091101 1 $42.90 $42.90 2
Emoquette Oral Tablet 0.15-30 Enpresse-28 Oral Tablet QUALITEST 00603754049 28 $117.90 $1.40 00555904758 28 $164.92 $0.98 Enpresse-28 Oral Tablet TEVA/WOMENS HEALTH 51285051428 28 $164.92 $0.98 Enskyce Oral Tablet 0.15-30 - Errin Oral Tablet 0.35 Estarylla Oral Tablet 0.25-35 - Estrostep Fe Oral Tablet 1-20/1-30/1-35 Falmina Oral Tablet 0.1-20 - Femcon Fe Oral Tablet Chewable 0.4-35 Generess FE Oral Tablet Chewable 0.8-25 Gianvi Oral Tablet 3-0.02 Gildagia Oral Tablet 0.4-35 - Gildess 1.5/30 Oral Tablet 1.5-30 Gildess 1/20 Oral Tablet 1-20 Gildess FE 1.5/30 Oral Tablet 1.5-30 Gildess FE 1/20 Oral Tablet 1-20 Heather Oral Tablet 0.35 Introvale Oral Tablet 0.15-0.03 Jencycla Oral Tablet 0.35 Jolessa Oral Tablet 0.15-0.03 68180088211 28 $39.34 $1.41 00555034458 28 $221.49 $1.32 SANDOZ 00781405815 28 $96.69 $1.15 ACTAVIS 00430057045 28 $369.94 $4.40 NORTHSTAR RX 16714035901 28 $35.16 $1.26 ACTAVIS 00430048214 28 $537.60 $3.84 ACTAVIS 52544020431 28 $323.57 $3.85 00093542328 28 $70.81 $2.53 QUALITEST 00603359049 28 $134.52 $1.60 QUALITEST 00603760602 21 $28.94 $1.38 QUALITEST 00603760702 21 $28.66 $1.36 QUALITEST 00603760817 28 $173.60 $1.03 QUALITEST 00603760917 28 $171.93 $1.02 68462030329 28 $110.75 $1.32 SANDOZ 00781558491 91 $160.65 $1.77 68180087711 28 $36.92 $1.32 00555912366 91 $482.02 $1.77 Jolivette Oral Tablet 0.35 ACTAVIS 52544089228 28 $221.52 $1.32 Junel 1.5/30 Oral Tablet 1.5-30 00555902742 21 $86.81 $1.38 3
Junel 1/20 Oral Tablet 1-20 - Junel FE 1.5/30 Oral Tablet 1.5-30 Junel FE 1/20 Oral Tablet 1-20 Kariva Oral Tablet 0.15-0.02/0.01 (21/5) Kelnor 1/35 Oral Tablet 1-35 - Kurvelo Oral Tablet 0.15-30 - Larin 1/20 Oral Tablet 1-20 - Larin Fe 1.5/30 Oral Tablet 1.5-30 Larin Fe 1/20 Oral Tablet 1-20 Leena Oral Tablet 0.5/1/0.5-35 Lessina Oral Tablet 0.1-20 - 00555902542 21 $85.97 $1.36 00555902858 28 $173.61 $1.03 00555902658 28 $171.94 $1.02 00555905058 28 $359.88 $2.14 00555906458 28 $179.28 $1.07 68180084411 28 $30.93 $1.10 NORTHSTAR RX 16714040801 21 $28.66 $1.36 NORTHSTAR RX 16714040501 28 $28.94 $1.03 NORTHSTAR RX 16714040601 28 $28.66 $1.02 ACTAVIS 52544021928 28 $236.10 $1.41 00555901467 28 $104.89 $1.25 Levonest Oral Tablet NORTHSTAR RX 16714034001 28 $27.49 $0.98 Levonorgest-Eth Estrad 91-Day Oral Tablet 0.1-0.02 & 0.01 Levonorgest-Eth Estrad 91-Day Oral Tablet 0.15-0.03 Levonorgestrel Oral Tablet 0.75 Levonorgestrel Oral Tablet 1.5 Levonorgestrel-Ethinyl Estrad Oral Tablet 0.1-20 Levonorgestrel-Ethinyl Estrad Oral Tablet 0.1-20 Levonorgestrel-Ethinyl Estrad Oral Tablet 0.15-30 Levora 0.15/30 (28) Oral Tablet 0.15-30 Lo Loestrin Fe Oral Tablet 1-10 / 10 Loestrin 1.5/30 (21) Oral Tablet 1.5-30 PERRIGO CIST CEUTICAL LLC 68180084811 91 $268.55 $2.95 68180084311 91 $160.70 $1.77 45802084054 2 $36.56 $18.28 63704000901 1 $36.28 $36.28 68180085411 28 $35.16 $1.26 MYLAN 00378728753 28 $105.48 $1.26 MYLAN 00378655053 28 $92.79 $1.10 ACTAVIS 52544027928 28 $185.58 $1.10 ACTAVIS 00430042014 28 $539.28 $3.85 00071091648 21 $229.03 $2.18 4
Loestrin 1.5/30 (21) Oral Tablet 1.5-30 Loestrin 1/20 (21) Oral Tablet 1-20 Loestrin Fe 1.5/30 Oral Tablet 1.5-30 Loestrin Fe 1/20 Oral Tablet 1-20 Lomedia 24 FE Oral Tablet 1-20 (24) TEVA/WOMENS HEALTH 51285008297 21 $560.40 $5.34 TEVA/WOMENS HEALTH 51285007997 21 $560.40 $5.34 TEVA/WOMENS HEALTH 51285008370 28 $560.40 $4.00 TEVA/WOMENS HEALTH 51285008070 28 $560.40 $4.00 AMNEAL 65162031684 28 $268.61 $3.20 Loryna Oral Tablet 3-0.02 SANDOZ 00781565615 28 $212.43 $2.53 LoSeasonique Oral Tablet 0.1-0.02 & 0.01 Low-Ogestrel Oral Tablet 0.3-30 Lutera Oral Tablet 0.1-20 - TEVA/WOMENS HEALTH 51285009287 91 $651.60 $3.58 ACTAVIS 52544084728 28 $183.12 $1.09 ACTAVIS 52544094928 28 $210.96 $1.26 Lyza Oral Tablet 0.35 AFAXYS 50102010001 28 $16.07 $0.57 Marlissa Oral Tablet 0.15-30 - Microgestin 1.5/30 Oral Tablet 1.5-30 Microgestin 1/20 Oral Tablet 1-20 Microgestin FE 1.5/30 Oral Tablet 1.5-30 Microgestin FE 1/20 Oral Tablet 1-20 Minastrin 24 Fe Oral Tablet Chewable 1-20 (24) Mircette Oral Tablet 0.15-0.02/0.01 (21/5) Modicon (28) Oral Tablet 0.5-35 Mono-Linyah Oral Tablet 0.25-35 MonoNessa Oral Tablet 0.25-35 My Way Oral Tablet 1.5 68462038884 28 $30.92 $1.10 ACTAVIS 52544095121 21 $173.61 $1.38 ACTAVIS 52544095021 21 $171.94 $1.36 ACTAVIS 52544063128 28 $173.61 $1.03 ACTAVIS 52544063028 28 $171.94 $1.02 ACTAVIS 00430053514 28 $107.86 $3.85 TEVA/WOMENS HEALTH 51285011458 28 $702.00 $4.18 JANSSEN 50458017115 28 $419.86 $2.50 NORTHSTAR RX 16714036001 28 $32.23 $1.15 ACTAVIS 52544024728 28 $204.60 $1.22 GAVIS 43386062230 1 $36.56 $36.56 Myzilra Oral Tablet QUALITEST 00603762549 28 $82.47 $0.98 5
Necon 0.5/35 (28) Oral Tablet 0.5-35 Necon 1/35 (28) Oral Tablet 1-35 Necon 1/50 (28) Oral Tablet 1-50 Necon 10/11 (28) Oral Tablet 35 Necon 7/7/7 Oral Tablet 0.5/0.75/1-35 Next Choice One Dose Oral Tablet 1.5 ACTAVIS 52544055028 28 $192.84 $1.15 ACTAVIS 52544055228 28 $176.81 $1.05 ACTAVIS 52544024531 28 $88.41 $1.05 ACTAVIS 52544055428 28 $192.84 $1.15 ACTAVIS 52544093628 28 $193.18 $1.15 ACTAVIS 52544028754 1 $36.56 $36.56 Nora-BE Oral Tablet 0.35 ACTAVIS 52544062928 28 $221.52 $1.32 Norethindrone Oral Tablet 0.35 Norethindrone Oral Tablet 0.35 Norethindrone Oral Tablet 0.35 Norethindrone Oral Tablet 0.35 Norgestimate-Eth Estradiol Oral Tablet 0.25-35 Norgestim-Eth Estrad Triphasic Oral Tablet 0.18/0.215/0.25-35 Norinyl 1+35 (28) Oral Tablet 1-35 Norinyl 1+50 (28) Oral Tablet 1-50 68462030529 28 $110.75 $1.32 68180087611 28 $36.92 $1.32 MYLAN 00378727253 28 $110.76 $1.32 NORTHSTAR RX 16714007301 28 $36.92 $1.32 68462030984 28 $36.50 $1.30 68462056529 28 $117.96 $1.40 ACTAVIS 52544025928 28 $447.49 $2.66 ACTAVIS 52544026531 28 $243.94 $2.90 Nor-QD Oral Tablet 0.35 ACTAVIS 52544023528 28 $447.42 $2.66 Nortrel 0.5/35 (28) Oral Tablet 0.5-35 Nortrel 1/35 (21) Oral Tablet 1-35 Nortrel 1/35 (28) Oral Tablet 1-35 Nortrel 7/7/7 Oral Tablet 0.5/0.75/1-35 Ocella Oral Tablet 3-0.03 Ogestrel Oral Tablet 0.5-50 - 00555900867 28 $96.52 $1.15 00555900942 21 $88.50 $1.40 00555901058 28 $176.99 $1.05 00555901258 28 $193.38 $1.15 00555913179 28 $76.68 $2.74 ACTAVIS 52544084828 28 $134.77 $1.60 6
Orsythia Oral Tablet 0.1-20 - Ortho Micronor Oral Tablet 0.35 Ortho Tri-Cyclen (28) Oral Tablet 0.18/0.215/0.25-35 Ortho Tri-Cyclen Lo Oral Tablet 0.18/0.215/0.25-25 Ortho-Cept (28) Oral Tablet 0.15-30 Ortho-Cyclen (28) Oral Tablet 0.25-35 Ortho-Novum 1/35 (28) Oral Tablet 1-35 Ortho-Novum 7/7/7 (28) Oral Tablet 0.5/0.75/1-35 Ovcon-35 (28) Oral Tablet 0.4-35 Philith Oral Tablet 0.4-35 - Pimtrea Oral Tablet 0.15-0.02/0.01 (21/5) Pirmella 1/35 Oral Tablet 1-35 Pirmella 7/7/7 Oral Tablet 0.5/0.75/1-35 Plan B One-Step Oral Tablet 1.5 QUALITEST 00603763449 28 $105.48 $1.26 JANSSEN 50458019416 28 $274.61 $1.63 JANSSEN 50458019115 28 $250.99 $1.49 JANSSEN 50458025115 28 $832.39 $4.95 JANSSEN 50458019601 28 $64.15 $2.29 JANSSEN 50458019700 28 $41.83 $1.49 JANSSEN 50458017615 28 $423.00 $2.52 JANSSEN 50458017820 28 $37.93 $1.35 ACTAVIS 00430058045 28 $342.82 $4.08 NORTHSTAR RX 16714034701 28 $44.84 $1.60 NORTHSTAR RX 16714040401 28 $59.98 $2.14 68180089311 28 $29.47 $1.05 68180089211 28 $32.23 $1.15 TEVA/WOMENS HEALTH 51285014619 1 $39.00 $39.00 Plan B Oral Tablet 0.75 TEVA/WOMENS HEALTH 51285003820 2 $39.37 $19.68 Portia-28 Oral Tablet 0.15-30 Previfem Oral Tablet 0.25-35 - Quartette Oral Tablet 42-21-21-7 DAYS Quasense Oral Tablet 0.15-0.03 Reclipsen Oral Tablet 0.15-30 Safyral Oral Tablet 3-0.03-0.451 Seasonique Oral Tablet 0.15-0.03 &0.01 00555902058 28 $185.58 $1.10 QUALITEST 00603764217 28 $193.38 $1.15 TEVA/WOMENS HEALTH 51285043165 91 $355.20 $3.90 ACTAVIS 52544096691 91 $482.09 $1.77 ACTAVIS 52544095428 28 $236.10 $1.41 50419040303 28 $371.54 $4.42 TEVA/WOMENS HEALTH 51285008787 91 $651.60 $3.58 7
Solia Oral Tablet 0.15-30 - Sprintec 28 Oral Tablet 0.25-35 Sronyx Oral Tablet 0.1-20 - PRASCO LABORATORIES 66993061128 28 $183.12 $1.09 00555901658 28 $193.38 $1.15 ACTAVIS 52544096728 28 $210.96 $1.26 Syeda Oral Tablet 3-0.03 SANDOZ 00781565815 28 $230.04 $2.74 Take Action Oral Tablet 1.5 TEVA/WOMENS HEALTH 51285010088 1 $39.00 $39.00 Tilia Fe Oral Tablet 1-20/1-30/1-35 Tri-Estarylla Oral Tablet 0.18/0.215/0.25-35 Tri-Legest Fe Oral Tablet 1-20/1-30/1-35 Tri-Linyah Oral Tablet 0.18/0.215/0.25-35 TriNessa (28) Oral Tablet 0.18/0.215/0.25-35 Tri-Norinyl (28) Oral Tablet 0.5/1/0.5-35 Tri-Previfem Oral Tablet 0.18/0.215/0.25-35 Tri-Sprintec Oral Tablet 0.18/0.215/0.25-35 ACTAVIS 52544014331 28 $171.47 $2.04 SANDOZ 00781406015 28 $117.96 $1.40 00555903270 28 $285.76 $2.04 NORTHSTAR RX 16714036301 28 $39.32 $1.40 ACTAVIS 52544024828 28 $235.92 $1.40 ACTAVIS 52544027428 28 $487.87 $2.90 QUALITEST 00603766317 28 $235.92 $1.40 00555901858 28 $235.94 $1.40 Trivora (28) Oral Tablet ACTAVIS 52544029128 28 $164.92 $0.98 Velivet Oral Tablet 0.1/0.125/0.15-0.025 00555905167 28 $100.93 $1.20 Vestura Oral Tablet 3-0.02 ACTAVIS 52544098228 28 $70.81 $2.53 Viorele Oral Tablet 0.15-0.02/0.01 (21/5) Vyfemla Oral Tablet 0.4-35 - Wera Oral Tablet 0.5-35 - Wymzya Fe Oral Tablet Chewable 0.4-35 Yasmin 28 Oral Tablet 3-0.03 YAZ Oral Tablet 3-0.02 68462031884 28 $59.98 $2.14 68180087513 28 $134.51 $1.60 NORTHSTAR RX 16714037001 28 $16.09 $0.57 68180089811 28 $73.18 $2.61 50419040201 28 $93.30 $3.33 50419040501 28 $93.30 $3.33 8
Zarah Oral Tablet 3-0.03 ACTAVIS 52544098131 28 $230.05 $2.74 Zenchent FE Oral Tablet Chewable 0.4-35 Zenchent Oral Tablet 0.4-35 - Zovia 1/35E (28) Oral Tablet 1-35 Zovia 1/50E (28) Oral Tablet 1-50 AMNEAL 65162034784 28 $268.61 $3.20 ACTAVIS 52544095328 28 $269.02 $1.60 ACTAVIS 52544038328 28 $179.27 $1.07 ACTAVIS 52544038428 28 $199.74 $1.19 Source: Rx, Medispan Release date: June 2014 For additional price comparison information see: http://www.compliance.bayerweb.com/vermontawp.htm 9