Key
C | Covered - No restrictions |
Q | Has quantity limits |
S | Has step therapy |
P | Has prior authorization |
N | Not Covered |
| AARP MedicareRx Saver Plus (PDP) S5921-377 | EnvisionRxPlus Silver (PDP) S7694-034 | First Health Part D Premier (PDP) S5768-117 | HealthSpring Prescription Drug Plan-Reg 34 (PDP) S5932-033 | Humana Walmart-Preferred Rx Plan (PDP) S5884-116 | Reader''s Digest Value Rx (PDP) S0128-035 | SmartD Rx Saver (PDP) S0064-034 |
| C S | C | Q | Q | Q | Q | N |
| C S | C | QP | Q | Q | Q | N |
| N | N | N | N | N | N | N |
| N | N | Q S | Q | Q | Q | N |
| C | N | N | N | Q S | QP | N |
| C | C | Q | C | P | P | N |
| P | C | C | C | C | C | N |
| N | C | Q | Q | Q | N | N |
| N | C | Q | Q | Q | N | N |
| C | C | Q | Q | C | C | N |
| P | P | P | QP | P | P | N |
| C | C | C | Q | Q | Q | N |
| N | N | N | N | N | N | N |
| N | N | N | N | N | N | N |
| C | C | QP | Q | C | C | N |
| C | C | Q | C | Q | Q | N |
| C | C | N | N | N | N | N |
| P | N | N | P | N | N | N |
| C | N | N | N | N | N | N |
| N | N | Q S | N | N | N | N |
| N | N | N | N | N | N | N |
| N | N | N | N | N | N | N |
| C | N | Q | C | N | N | N |
| C | N | Q | C | N | N | N |
| C | N | C | C | C | C | N |
| AARP MedicareRx Saver Plus (PDP) S5921-377 | EnvisionRxPlus Silver (PDP) S7694-034 | First Health Part D Premier (PDP) S5768-117 | HealthSpring Prescription Drug Plan-Reg 34 (PDP) S5932-033 | Humana Walmart-Preferred Rx Plan (PDP) S5884-116 | Reader''s Digest Value Rx (PDP) S0128-035 | SmartD Rx Saver (PDP) S0064-034 |
| C | P | C | C | P | P | N |
| C | C | Q | Q S | N | N | N |
| C | C | Q | Q S | N | N | N |
| N | C | QP | N | QP | QP | N |
| N | N | QP | N | N | N | N |
| P | N | QP | N | QP | QP | N |
| C | N | QP | Q | Q S | QP | N |
| C | N | Q | N | N | N | N |
| C | C | C | C | C | C | N |
| C | N | C | C | C | C | N |
| C | C | C | C | C | C | N |
| N | C | Q | Q S | N | N | N |
| P | P | P | P | P | P | N |
| C | Q | QP | QP | Q | Q | N |
| C | C | Q | C | Q | Q | N |
| P | C | QP | QP | QP | QP | N |
| N | N | N | N | N | N | N |
| P | N | P | P | P | P | N |
| C | C | C | C | C | C | N |
| C | C | Q | Q | Q | Q | N |
| N | N | N | N | C | C | N |
| C S | C | Q S | C | C | C | N |
| N | C S | Q S | N | N | N | N |
| C | C | P | Q | Q | Q | N |
| P | N | N | N | QP | QP | N |
| AARP MedicareRx Saver Plus (PDP) S5921-377 | EnvisionRxPlus Silver (PDP) S7694-034 | First Health Part D Premier (PDP) S5768-117 | HealthSpring Prescription Drug Plan-Reg 34 (PDP) S5932-033 | Humana Walmart-Preferred Rx Plan (PDP) S5884-116 | Reader''s Digest Value Rx (PDP) S0128-035 | SmartD Rx Saver (PDP) S0064-034 |
| C | C | Q | Q | Q | Q | N |
| C | N | Q | Q | Q | Q | N |
| C S | Q | Q | Q | Q | Q | N |
| C | Q S | Q | Q | Q | Q | N |
| N | N | N | N | N | N | N |
| N | N | Q | N | N | N | N |
| C | N | N | N | N | N | N |
| P | C | QP | QP | Q S | Q S | N |
| C | C | Q | Q S | N | N | N |
| C | C | N | N | Q | Q | N |
| C | C | Q | Q | C | C | N |
| N | N | N | C | Q | Q | N |
| N | N | N | C | C | C | N |
| N | N | N | C | C | C | N |
| N | N | N | C | C | C | N |
| N | N | N | C | C | C | N |
| N | N | Q | N | Q | Q | N |
| N | N | N | N | N | N | N |
| C | C | QP | Q S | Q S | Q S | N |
| N | N | N | N | N | N | N |
| P | P | P | QP | QP | QP | N |
| N | N | N | N | N | N | N |
| C | N | Q | C | Q | Q | N |
| N | N | N | N | N | N | N |
| N | N | N | N | N | N | N |
| AARP MedicareRx Saver Plus (PDP) S5921-377 | EnvisionRxPlus Silver (PDP) S7694-034 | First Health Part D Premier (PDP) S5768-117 | HealthSpring Prescription Drug Plan-Reg 34 (PDP) S5932-033 | Humana Walmart-Preferred Rx Plan (PDP) S5884-116 | Reader''s Digest Value Rx (PDP) S0128-035 | SmartD Rx Saver (PDP) S0064-034 |
| C | C | C | C | C | C | N |
| N | N | N | N | N | N | N |
| P | C | C | C | C | C | N |
| C | Q | Q | QP | QP | QP | N |
| C | N | C | N | N | N | N |
| C | C | Q | Q | Q | Q | N |
| C | N | N | Q | N | N | N |
| C | C | Q | Q | Q | Q | N |
| N | N | Q | N | N | N | N |
| C | C | P | QP | QP | QP | N |
| C | N | Q | N | N | N | N |
| N | N | N | N | N | N | N |
| C | C | C | C | Q | Q | N |
| P | N | N | C | N | N | N |
| C | C | Q | Q | Q | C | N |
| C | C | Q | Q | Q | Q | N |
| C | N | Q | Q | Q | Q | N |
| P | C | P | P | QP | QP | N |
| C | N | Q | Q | N | N | N |
| C | N | C | C | N | N | N |
| C | N | C | N | N | N | N |
| C | C | C | N | C | C | N |
| N | C | C | N | C | C | N |
| C | C | C | N | C | C | N |
| N | N | QP | N | N | N | N |
| AARP MedicareRx Saver Plus (PDP) S5921-377 | EnvisionRxPlus Silver (PDP) S7694-034 | First Health Part D Premier (PDP) S5768-117 | HealthSpring Prescription Drug Plan-Reg 34 (PDP) S5932-033 | Humana Walmart-Preferred Rx Plan (PDP) S5884-116 | Reader''s Digest Value Rx (PDP) S0128-035 | SmartD Rx Saver (PDP) S0064-034 |
| C | C | Q | Q | Q | Q | N |
| P | QP | C | Q | QP | QP | N |
| P | QP | P | Q | QP | QP | N |
| P | QP | N | Q | QP | QP | N |
| C | C | Q | N | Q S | Q S | N |
| N | C | N | QP | N | N | N |
| N | N | N | N | N | N | N |
| C | C | Q | Q | Q | Q | N |
| C | C | Q | C | C | C | N |
| N | N | N | N | N | N | N |
| P | C | Q | N | Q | Q | N |
| N | N | N | N | N | N | N |
| N | N | N | N | N | N | N |
| N | N | N | N | N | N | N |
| P | QP | QP | P | QP | QP | N |
| P | P | N | P | P | P | N |
| P | N | QP | Q S | QP | QP | N |
| C | N | C | C | N | N | N |
| C | N | C | P | N | N | N |
| C | N | N | C | N | N | N |
| N | N | N | N | C | C | N |
| P | N | N | N | N | N | N |
| P | N | N | N | N | N | N |
| C | C | N | N | N | N | N |
| C S | C | Q S | Q S | N | Q S | N |
| AARP MedicareRx Saver Plus (PDP) S5921-377 | EnvisionRxPlus Silver (PDP) S7694-034 | First Health Part D Premier (PDP) S5768-117 | HealthSpring Prescription Drug Plan-Reg 34 (PDP) S5932-033 | Humana Walmart-Preferred Rx Plan (PDP) S5884-116 | Reader''s Digest Value Rx (PDP) S0128-035 | SmartD Rx Saver (PDP) S0064-034 |
| P | C | N | P | QP | QP | N |
| P | N | QP | P | C | C | N |
| N | N | N | N | N | N | N |
| P | P | N | N | QP | QP | N |
| N | N | Q | N | N | N | N |
| C | C | Q | C | Q | Q | N |
| C | C | Q | Q | Q | Q | N |
| N | N | N | Q | N | N | N |
| N | N | N | N | N | N | N |
| N | N | N | N | N | N | N |
| C | C | P | Q | Q | Q | N |
| N | N | N | N | N | N | N |
| C | C | C | N | N | N | N |
| C | C | Q | Q | Q | Q | N |
| C | C | Q | C | Q | Q | N |
| N | N | N | N | N | N | N |
| C | C | C | C | C | C | N |
| C | N | N | Q | N | N | N |
| C | C | Q | Q | Q | Q | N |
| N | N | N | C | Q | Q | N |
| N | N | Q | C | N | N | N |
| C S | C S | N | C S | N | N | N |
| N | N | N | N | N | N | N |
| P | P | QP | Q | P | P | N |
| C | N | Q | Q S | C | C | N |
| AARP MedicareRx Saver Plus (PDP) S5921-377 | EnvisionRxPlus Silver (PDP) S7694-034 | First Health Part D Premier (PDP) S5768-117 | HealthSpring Prescription Drug Plan-Reg 34 (PDP) S5932-033 | Humana Walmart-Preferred Rx Plan (PDP) S5884-116 | Reader''s Digest Value Rx (PDP) S0128-035 | SmartD Rx Saver (PDP) S0064-034 |
| N | N | N | N | N | N | N |
| N | N | N | N | N | N | N |
| N | N | QP | N | N | N | N |
| P | C | Q | QP | Q | Q | N |
| C | C | N | QP | QP | QP | N |
| N | N | N | N | N | N | N |
| N | N | Q | N | N | N | N |
| N | N | N | N | N | N | N |
| C | C | Q | Q | Q | Q | N |
| C | C | Q | Q | Q | Q | N |
| C | N | N | C | N | N | N |
| C | N | N | N | Q | Q | N |
| N | N | N | N | N | N | N |
| P | C | QP | P | C | C | N |