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Medications listed are available on OH EPIC Formulary, unless otherwise noted.
Not all formulary medications are available at each facility. Please refer to your local pharmacy for available inventory.
Search results for:

levonorgestrel

levonorgestrel
Drug Name Form Strength Infusion Center Available Restricted Non-formulary Ambulatory Available Interchange REMS
Kyleena DEVICE, INTRAUTERINE -          
Liletta DEVICE, INTRAUTERINE -          
Mirena DEVICE, INTRAUTERINE -          
Plan B TABLET, ORAL -          
VIEW MORE Contraceptives
CLASS
681200
Additional Information and Links

Restricted: Long-acting reversible contraceptives (LARCs) to be ordered by OB-GYN Specialists.

I. Inpatient options:

  1. Mirena (restricted to Medicaid patients)
  2. Nexplanon (restricted to Medicaid patients)
  3. Paragard (restricted to Medicaid patients)

II. Outpatient (clinic, outpatient surgery) options:

  1. Mirena (primary/preferred)
  2. Liletta
  3. Kyleena
  4. Nexplanon
  5. Paragard

Restricted Criteria for Tablet for Sexual Assault:

  1. Levonorgestrel (Plan B One Step) restricted to weight ≤ 80 Kg, BMI ≤ 30 kg/m2, due to decreased efficacy in obese patients AND use within 72 hours of unprotected intercourse

 

Last updated: Aug. 29, 2024

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