Health Care Professionals

A change in one electronic database may limit your patients’ access to important prescription prenatal vitamins

Dear Doctor,

We at Mission Pharmacal Company (“Mission Pharmacal”) wish to make you aware that First Databank (“FDB”), an electronic drug coding database, has made an incorrect decision to either delete prescription prenatal vitamins from the FDB database or reclassify prescription prenatal vitamins into a new category on the FDB database. Many prenatal vitamins, previously classified as prescription products in the FDB database, now fall under a new “Q” category in FDB’s database for products that are neither prescription drugs nor medical devices, such as dietary supplements. One result of such incorrect action by FDB is that the CitraNatal® prescription prenatal vitamins of Mission Pharmacal have been wrongfully deleted by FDB from its database.

FDB’s action in this matter could lead to certain denials of insurance coverage for prenatal vitamins. Moreover, FDB’s decision contradicts statements from the U.S. Food and Drug Administration (“FDA”), which recognizes the importance of prenatal vitamins containing folic acid, and has stated that physicians can and do write prescriptions for prenatal vitamins.

It is our belief that expectant mothers deserve to have their nutritional needs evaluated by a qualified, expert medical professional and receive the highest standard of care throughout their pregnancy. However, FDB’s action could prevent mothers-to-be from getting the nutritional support that’s critical to the healthy development of their babies.

Please be aware that all of the other drug coding databases have not made any change to the classification of prescription prenatal vitamins from Mission Pharmacal. These other drug coding databases, such as Medi-Span and others, are used in numerous national and regional pharmacies, including Walgreens, WalMart, H.E.B. and others, which means that your patients should not have any problems filling your prescriptions for the CitraNatal® brand of prescription prenatal vitamins made by Mission Pharmacal at such pharmacies.

In a recent independent survey by the March of Dimes:
50% of women reported that they took prescription prenatal vitamins during their current/last pregnancy, and 88% said it was
covered by their insurance.1

Why prescription prenatal vitamins are so important
CitraNatal® prescription prenatal vitamins
are formulated with optimal levels of nutrients, such as folic acid, iron, vitamin B12, vitamin C, and DHA, among others. In addition, many of our CitraNatal® prenatal vitamin formulations also contain vitamin B6 and a stool softener.

Did you know?
Up to 70%
of the 3,000 neural tube defects that occur each year in the U.S. could be prevented if all women of childbearing potential took a prenatal vitamin containing folic acid.2,3

CitraNatal® Rx Nutritionals will continue to be available – regardless of changes by FDB

We’re doing our part to support mothers-to-be – nutritionally and financially
We at Mission Pharmacal are taking measures to provide all patients with access to our prenatal
nutritional supplements.

  • For patients with commercial insurance coverage, we offer a savings card allowing patients to pay as little as $30*, which we will continue to provide and can be downloaded from the website.
  • CitraNatal® also continues to be available through managed care plans like Caremark and Express Scripts®, as well as through CVS Caremark® mail order for Caremark members. State Medicaid plans will continue to operate under current conditions, based on plan and member benefit coverage.
    * Subject to eligibility. Terms and conditions apply.

Let’s continue to support expectant mothers and their babies
The first recommendations regarding folic acid supplementation were made back in 1992 by the U.S. Public Health Service.2 Mission Pharmacal stands with you in supporting these recommendations and ensuring that every mother-to-be has access to the nutritional support she and her baby need.

If you have questions about this change by FDB or access to CitraNatal® Rx Nutritional tablets for specific patients, please speak with one of our Customer Service agents.

Contact Mission Pharmacal Customer Service at:
(800) 531-3333
Monday-Wednesday, 7:00 am to 5:30 pm CST,
and Thursday, 7:00 am to 5:00 pm CST

Have questions or concerns about this change by FDB?

If you have questions about this change by FDB or access to CitraNatal® Rx Nutritional tablets for specific patients, please speak with one of our Customer Service agents.

Contact Mission Pharmacal Customer Service at:
(800) 531-3333
Monday-Wednesday, 7:00 am to 5:30 pm CST,
and Thursday, 7:00 am to 5:00 pm CST

References: 1. March of Dimes. Fewer than half of U.S. women take recommended vitamins prior to pregnancy, according to March of Dimes new Prenatal Health & Nutrition Survey. Published September 19, 2017. Accessed December 2021. 2. ACOG Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin 187: clinical management guidelines for obstetrician-gynecologists. Obstet & Gynecol. 2017;130(6):e279-e290. doi:10.1097/AOG.0000000000002412. 3. Centers for Disease Control and Prevention (CDC). Folic Acid & Neural Tube Defects: An Overview. Accessed December 2021.

DHA soft gels and CitraNatal Harmony soft gels are MADE IN CANADA for:
San Antonio, TX USA
78230 1355

Prenatal tablets manufactured by:
San Antonio, TX USA
78230 1355

CitraNatal Harmony, CitraNatal Assure, CitraNatal B-Calm, CitraNatal 90 DHA and CitraNatal Bloom contain Ferr-Ease®.


INDICATIONS: CitraNatal Harmony®, CitraNatal Assure®, CitraNatal B-Calm®*, CitraNatal® 90 DHA, and CitraNatal Bloom® are multi-vitamin/mineral prescription drugs indicated for use in improving the nutritional status of women prior to conception, throughout pregnancy, and in the postnatal period for both lactating and nonlactating mothers.

*CitraNatal B-Calm may be used in conjunction with a physician prescribed regimen to help minimize pregnancy related nausea and vomiting.

Important Safety Information

CONTRAINDICATIONS: These products are contraindicated in patients with a known hypersensitivity to any of the ingredients.

WARNING: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. KEEP THESE PRODUCTS OUT OF THE REACH OF CHILDREN. In case of accidental overdose, call a doctor or poison control center immediately.

WARNING: More than 3 grams total intake per day of omega-3 fatty acids from all sources, including both food and supplements (like Docosahexaenoic Acid [DHA] and Eicosapentaenoic Acid [EPA]), have been shown to have potential antithrombotic effects, including an increased bleeding time and INR. Administration of omega-3 fatty acids should be avoided in patients on anticoagulants and in those known to have an inherited or acquired bleeding diathesis.

CitraNatal B-Calm and CitraNatal Bloom do not contain DHA.

WARNING: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient.

See full Prescribing Information for additional information including Precautions and Adverse Reactions.