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) S5921-359 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-048 | EnvisionRxPlus Silver (PDP) S7694-014 | Humana Walmart-Preferred Rx Plan (PDP) S5884-137 | SecureAdvantage Rx - Option 1 (PDP) S9014-001 | SilverScript Basic (PDP) S5601-028 | SmartD Rx Saver (PDP) S0064-014 | United American - Select (PDP) S5755-085 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H3659-058 | UnitedHealthcare Nursing Home Plan (PPO SNP) H2406-001 |
| C S | Q | C | Q | Q | Q | N | Q | C | C |
| C S | Q | C | Q | Q | Q | N | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | Q | QP | N | N | QPS | C | C |
| C | Q | N | Q S | Q | Q | N | Q | C | C |
| C | C | C | P | C | C | N | C | C | C |
| P | P | C | C | C | P | N | C | P | P |
| N | Q | C | Q | Q | Q | N | N | C | C |
| N | Q | C | Q | Q | Q | N | N | C | C |
| C | Q | C | C | C | C | N | C | C | C |
| P | P | P | P | P | P | N | P | P | P |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| C | Q | C | C | C | Q S | N | C | C | C |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| C | N | C | N | Q | N | N | N | C | C |
| P | P | N | N | QP | P | N | QP | P | P |
| C | N | N | N | N | N | N | N | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| C | C | N | N | C | C | N | N | C | C |
| C | C | N | N | C | C | N | N | C | C |
| C | C | N | C | C | C | N | N | C | C |
| AARP MedicareRx Saver Plus (PDP) S5921-359 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-048 | EnvisionRxPlus Silver (PDP) S7694-014 | Humana Walmart-Preferred Rx Plan (PDP) S5884-137 | SecureAdvantage Rx - Option 1 (PDP) S9014-001 | SilverScript Basic (PDP) S5601-028 | SmartD Rx Saver (PDP) S0064-014 | United American - Select (PDP) S5755-085 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H3659-058 | UnitedHealthcare Nursing Home Plan (PPO SNP) H2406-001 |
| C | P | P | P | P | P | N | P | C | C |
| C | Q | C | N | Q | Q | N | N | C | C |
| C | Q | C | N | Q | Q | N | N | C | C |
| N | N | C | QP | QP | QP | N | QP | P | P |
| N | QP | N | N | N | QP | N | N | P | P |
| P | N | N | QP | N | N | N | N | P | P |
| C | Q | N | Q S | C | QP | N | C | C | C |
| C | C | N | N | C | C | N | C | C | C |
| C | C | C | C | C | C | N | C | C | C |
| C | C | N | C | C | C | N | C | C | C |
| C | C | C | C | C | C | N | C | C | C |
| N | C | C | N | Q | QP | N | Q | C | C |
| P | P | P | P | P | P | N | P | P | P |
| C | Q S | Q | Q | QP | QP | N | QP | C | C |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| P | QP | C | QP | QP | QP | N | QP | P | P |
| N | N | N | N | N | N | N | N | N | N |
| P | N | N | P | P | P | N | P | P | P |
| C | P | C | C | C | C | N | C | C | C |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| N | C | N | C | N | N | N | N | N | N |
| C S | Q S | C | C | C | P | N | C | C S | C S |
| N | N | C S | N | Q | N | N | N | N | N |
| C | C | C | Q | C | Q | N | C | C | C |
| P | N | N | QP | QP | N | N | QP | P | P |
| AARP MedicareRx Saver Plus (PDP) S5921-359 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-048 | EnvisionRxPlus Silver (PDP) S7694-014 | Humana Walmart-Preferred Rx Plan (PDP) S5884-137 | SecureAdvantage Rx - Option 1 (PDP) S9014-001 | SilverScript Basic (PDP) S5601-028 | SmartD Rx Saver (PDP) S0064-014 | United American - Select (PDP) S5755-085 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H3659-058 | UnitedHealthcare Nursing Home Plan (PPO SNP) H2406-001 |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| C | C | N | Q | C | Q | N | C | C | C |
| C S | C | Q | Q | Q | Q | N | Q | C S | C S |
| C | Q | Q S | Q | Q | QP | N | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | C | N | N | C | N | N |
| C | N | N | N | C | N | N | C | C | C |
| P | Q S | C | Q S | Q | QP | N | Q | P | P |
| C | C | C | N | C | C | N | C | C | C |
| C | N | C | Q | C | N | N | C | C | C |
| C | QPS | C | C | C | Q | N | C | C | C |
| N | N | N | Q | Q | N | N | Q | C | C |
| N | N | N | C | Q | N | N | Q | C | C |
| N | C | N | C | Q | N | N | Q | C | C |
| N | N | N | C | Q | N | N | Q | C | C |
| N | C | N | C | Q | N | N | Q | C | C |
| N | QP | N | Q | C | QP | N | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| C | Q | C | Q S | Q | Q | N | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| P | QP | P | QP | P | P | N | P | P | P |
| N | N | N | N | N | N | N | N | N | N |
| C | Q | N | Q | Q | N | N | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| AARP MedicareRx Saver Plus (PDP) S5921-359 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-048 | EnvisionRxPlus Silver (PDP) S7694-014 | Humana Walmart-Preferred Rx Plan (PDP) S5884-137 | SecureAdvantage Rx - Option 1 (PDP) S9014-001 | SilverScript Basic (PDP) S5601-028 | SmartD Rx Saver (PDP) S0064-014 | United American - Select (PDP) S5755-085 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H3659-058 | UnitedHealthcare Nursing Home Plan (PPO SNP) H2406-001 |
| C | C | C | C | Q | C | N | Q | C | C |
| N | Q S | N | N | N | N | N | N | N | N |
| P | P | C | C | C | C | N | C | P | P |
| C | QPS | Q | QP | P | Q | N | P | C | C |
| C | C | N | N | C | C | N | C | C | C |
| C | Q | C | Q | C | C | N | C | C | C |
| C | N | N | N | C | N | N | C | C | C |
| C | C | C | Q | C | Q | N | C | C | C |
| N | N | N | N | Q | Q | N | N | C | C |
| C | P | C | QP | C | QP | N | C | C | C |
| C | N | N | N | Q | Q | N | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| C | C | C | Q | C | C | N | C | C | C |
| P | N | N | N | N | N | N | N | P | P |
| C | Q | C | Q | C | Q | N | C | C | C |
| C | C | C | Q | Q | Q | N | Q | C | C |
| C | C | N | Q | C | Q | N | N | C | C |
| P | P | C | QP | QP | P | N | QP | P | P |
| C | C | N | N | Q | N | N | N | C | C |
| C | C | N | N | C | C | N | C | C | C |
| C | C | N | N | C | C | N | C | C | C |
| C | C | C | C | Q | C | N | N | C | C |
| N | C | C | C | Q | C | N | N | C | C |
| C | C | C | C | Q | C | N | N | C | C |
| N | N | N | N | N | N | N | N | N | N |
| AARP MedicareRx Saver Plus (PDP) S5921-359 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-048 | EnvisionRxPlus Silver (PDP) S7694-014 | Humana Walmart-Preferred Rx Plan (PDP) S5884-137 | SecureAdvantage Rx - Option 1 (PDP) S9014-001 | SilverScript Basic (PDP) S5601-028 | SmartD Rx Saver (PDP) S0064-014 | United American - Select (PDP) S5755-085 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H3659-058 | UnitedHealthcare Nursing Home Plan (PPO SNP) H2406-001 |
| C | C | C | Q | Q | Q | N | Q | C | C |
| P | QP | QP | QP | QP | P | N | QP | P | P |
| P | QP | QP | QP | QP | P | N | QP | P | P |
| P | QP | QP | QP | QP | P | N | QP | P | P |
| C | N | C | Q S | Q | N | N | Q | C | C |
| N | N | C | N | Q | Q | N | Q | N | N |
| N | N | N | N | N | N | N | N | N | N |
| C | C | C | Q | Q | N | N | Q | C | C |
| C | C | C | C | C | C | N | C | C | C |
| N | Q | N | N | N | N | N | N | N | N |
| P | Q | C | Q | C | C | N | C | P | P |
| N | N | N | N | N | N | N | N | 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 | QP | QP | P | N | QP | P | P |
| P | P | P | P | C | P | N | C | P | P |
| P | QP | N | QP | C S | Q | N | N | P | P |
| C | N | N | N | C | C | N | C | C | C |
| C | P | N | N | C | P | N | C | C | C |
| C | N | N | N | N | N | N | N | C | C |
| N | N | N | C | N | N | N | N | C | C |
| P | QP | N | N | QP | QP | N | QP | P | P |
| P | N | N | N | P | QP | N | P | P | P |
| C | N | C | N | N | N | N | N | C | C |
| C S | Q S | C | N | C | QP | N | C | C S | C S |
| AARP MedicareRx Saver Plus (PDP) S5921-359 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-048 | EnvisionRxPlus Silver (PDP) S7694-014 | Humana Walmart-Preferred Rx Plan (PDP) S5884-137 | SecureAdvantage Rx - Option 1 (PDP) S9014-001 | SilverScript Basic (PDP) S5601-028 | SmartD Rx Saver (PDP) S0064-014 | United American - Select (PDP) S5755-085 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H3659-058 | UnitedHealthcare Nursing Home Plan (PPO SNP) H2406-001 |
| P | N | C | QP | C | N | N | C | P | P |
| P | QP | N | C | P | P | N | P | P | P |
| N | N | N | N | N | N | N | N | N | N |
| P | QP | P | QP | QP | QP | N | QP | P | P |
| N | N | N | N | N | N | N | N | N | N |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| N | N | N | N | N | N | N | N | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | C | C |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| C | C | C | N | C | C | N | C | C | C |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| C | Q | C | Q | Q | Q | N | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| C | C | C | C | C | C | N | C | C | C |
| C | N | N | N | C | N | N | N | C | C |
| C | C | C | Q | C | Q | N | C | C | C |
| N | C | N | Q | N | Q | N | N | C | C |
| N | C | N | N | C | Q | N | N | C | C |
| C S | C | C S | N | C | C S | N | C | C S | C S |
| N | N | N | N | N | N | N | N | N | N |
| P | P | P | P | P | P | N | P | P | P |
| C | Q | N | C | C | C | N | C | C | C |
| AARP MedicareRx Saver Plus (PDP) S5921-359 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-048 | EnvisionRxPlus Silver (PDP) S7694-014 | Humana Walmart-Preferred Rx Plan (PDP) S5884-137 | SecureAdvantage Rx - Option 1 (PDP) S9014-001 | SilverScript Basic (PDP) S5601-028 | SmartD Rx Saver (PDP) S0064-014 | United American - Select (PDP) S5755-085 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H3659-058 | UnitedHealthcare Nursing Home Plan (PPO SNP) H2406-001 |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| N | Q | N | N | N | N | N | N | C | C |
| P | Q | C | Q | C | N | N | C | P | P |
| C | N | C | QP | Q | P | N | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | Q | Q | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| C | Q | C | Q | Q | C | N | Q | C | C |
| C | QP | C | Q | Q | Q | N | Q | C | C |
| C | N | N | N | C | N | N | C | C | C |
| C | C | N | Q | N | N | N | N | C | C |
| N | N | N | N | N | N | N | N | N | N |
| P | QP | C | C | Q | C | N | Q | P | P |