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) S5921-357 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-046 | Cigna Medicare Rx Secure (PDP) S5617-220 | Cigna-HealthSpring Rx -Reg12 (PDP) S5932-001 | Express Scripts Medicare - Value (PDP) S5660-114 | Humana Preferred Rx Plan (PDP) S5884-106 | SilverScript Basic (PDP) S5601-024 | SmartD Rx Saver (PDP) S0064-012 | United American - Select (PDP) S5755-083 | WellCare Classic (PDP) S5967-149 | Windsor Rx (PDP) S2505-001 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H0408-002 |
| Q | Q | Q | Q | Q | Q | Q | N | Q | QP | Q | Q |
| Q | Q | Q | Q | Q | Q | Q | N | Q | QP | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | C | Q | Q | N | N | N | Q S | N | N | C |
| N | N | N | N | N | N | N | N | N | N | N | N |
| C | C | C | C | C | P | C | N | C | C | C | C |
| P | P | P | C | P | C | P | N | P | C | P | P |
| N | Q | C | Q | Q | N | Q | N | Q | Q | Q | Q |
| N | Q | C | Q | Q | N | Q | N | Q | Q | Q | C |
| C | Q | Q | Q | C | N | C | N | C | C | C | C |
| P | P | P | QP | P | P | P | N | P | P | P | P |
| C | Q | C | Q | Q | Q | Q | N | Q | Q | Q | 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 |
| Q | Q | Q | Q | C | N | Q | N | C | C S | Q | Q |
| C | C | Q | C | C | Q | Q | N | C | Q | Q | C |
| N | N | N | N | N | N | N | N | N | N | N | C |
| P | P | P | P | N | N | P | N | P | N | P | P |
| C | N | N | N | N | N | N | N | N | N | N | 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 | N | N | N | N | N | N |
| C | N | Q | C | N | N | N | N | C | N | N | C |
| C | N | Q | C | N | N | N | N | C | N | N | C |
| C | C | C | C | N | C | N | N | C | N | N | C |
| AARP MedicareRx Saver Plus (PDP) S5921-357 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-046 | Cigna Medicare Rx Secure (PDP) S5617-220 | Cigna-HealthSpring Rx -Reg12 (PDP) S5932-001 | Express Scripts Medicare - Value (PDP) S5660-114 | Humana Preferred Rx Plan (PDP) S5884-106 | SilverScript Basic (PDP) S5601-024 | SmartD Rx Saver (PDP) S0064-012 | United American - Select (PDP) S5755-083 | WellCare Classic (PDP) S5967-149 | Windsor Rx (PDP) S2505-001 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H0408-002 |
| C | P | C | C | P | P | P | N | P | P | P | C |
| C | Q | Q | Q S | C | Q | Q | N | C S | N | Q | C |
| C | Q | Q | Q S | C | Q | Q | N | C S | N | Q | C |
| N | N | N | N | N | N | P | N | QP | P | QP | P |
| N | N | P | N | N | N | N | N | N | N | N | P |
| P | N | N | N | N | QP | N | N | N | N | N | P |
| C | N | Q | Q | Q | Q S | N | N | QP | C | N | C |
| C | N | Q | N | C | N | C | N | C | C | C | C |
| C | C | C | C | C | C | C | N | C | C | C | C |
| N | Q | Q | C | C | Q | N | N | C | N | N | N |
| C | C | C | C | C | C | C | N | C | C | C | C |
| C | C | C | C | C | C | C | N | C | C | C | C |
| N | N | Q | Q S | C | N | Q | N | C S | C | Q | C |
| P | P | P | P | P | P | P | N | P | P | P | P |
| C | Q | Q | QP | C | Q | QP | N | C | Q | QP | C |
| C | C | C | C | C | Q | Q | N | C | C | Q | C |
| P | QP | P | QP | QP | QP | P | N | QP | QP | QP | P |
| N | N | N | N | N | N | N | N | N | N | N | N |
| P | N | P | P | C | P | P | N | C | P | P | P |
| C | P | P | C | C | C | C | N | C | C | C | C |
| C | Q | Q | Q | C | Q | Q | N | C | C | Q | C |
| N | N | N | N | N | N | N | N | N | N | N | N |
| C S | Q S | C | C | N | C | P | N | N | P | P | C S |
| N | C | N | N | N | N | N | N | C | N | N | N |
| Q | C | Q | Q | C | Q | C | N | C | Q | C | Q |
| P | N | P | N | N | QP | N | N | P | N | N | P |
| AARP MedicareRx Saver Plus (PDP) S5921-357 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-046 | Cigna Medicare Rx Secure (PDP) S5617-220 | Cigna-HealthSpring Rx -Reg12 (PDP) S5932-001 | Express Scripts Medicare - Value (PDP) S5660-114 | Humana Preferred Rx Plan (PDP) S5884-106 | SilverScript Basic (PDP) S5601-024 | SmartD Rx Saver (PDP) S0064-012 | United American - Select (PDP) S5755-083 | WellCare Classic (PDP) S5967-149 | Windsor Rx (PDP) S2505-001 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H0408-002 |
| C | Q | Q | Q | Q | Q | Q | N | Q | Q | Q | C |
| C | C | C | C | C | N | C | N | C | C | C | C |
| N | N | P | N | C | N | Q | N | Q S | N | QP | Q |
| N | N | N | N | N | N | N | N | N | N | N | N |
| C S | C | Q | Q | C | Q | Q | N | C | Q | Q | C S |
| N | C | Q | C | C | Q | C | N | C | N | C | C |
| Q | Q | Q | Q | Q | Q | Q | N | Q | Q | QP | Q |
| N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | Q | N | N | N | Q | N | N | N |
| C | N | N | N | C | N | N | N | C | N | N | C |
| P | Q S | C | QP | QP | Q S | QP | N | QP | QP | QP | P |
| C | C | C | Q S | N | N | C | N | N | C | C | C |
| C | N | N | N | C | Q | N | N | C | N | N | C |
| C | C | C | Q | C | C | Q | N | C | Q | Q | C |
| N | N | C | C | C | Q | N | N | C | Q | N | C |
| N | N | C | C | C | C | N | N | C | Q | N | C |
| N | C | C | C | C | C | N | N | C | Q | N | C |
| N | N | C | C | C | C | N | N | C | Q | N | C |
| N | C | C | C | C | C | N | N | C | Q | N | C |
| N | N | P | Q | Q | N | QP | N | QP | QP | QP | P |
| N | N | N | N | N | N | N | N | N | N | N | N |
| Q | Q | Q | Q S | Q | Q S | Q | N | Q | QP | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N | N |
| P | P | P | QP | QP | QP | P | N | QP | P | P | P |
| N | N | N | N | N | N | N | N | N | N | N | N |
| C | Q | Q | C | C | Q | N | N | C | N | N | 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 |
| AARP MedicareRx Saver Plus (PDP) S5921-357 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-046 | Cigna Medicare Rx Secure (PDP) S5617-220 | Cigna-HealthSpring Rx -Reg12 (PDP) S5932-001 | Express Scripts Medicare - Value (PDP) S5660-114 | Humana Preferred Rx Plan (PDP) S5884-106 | SilverScript Basic (PDP) S5601-024 | SmartD Rx Saver (PDP) S0064-012 | United American - Select (PDP) S5755-083 | WellCare Classic (PDP) S5967-149 | Windsor Rx (PDP) S2505-001 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H0408-002 |
| C | C | C | C | C | C | C | N | C | Q | C | C |
| N | N | N | N | N | N | N | N | N | N | N | N |
| P | P | C | C | C | C | P | N | C | C | P | P |
| Q | QPS | Q | N | P | QP | Q | N | P | Q | N | Q |
| C | C | C | N | C | N | C | N | C | C | C | C |
| C | C | C | Q | C | Q | C | N | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N | N |
| C | C | Q | Q | C | Q | C | N | C | Q | C | C |
| N | N | P | N | N | N | Q | N | Q S | N | QP | Q |
| P | P | P | QP | P | QP | QP | N | P | N | QP | P |
| C | N | C | N | C | N | Q | N | C | N | QP | P |
| N | N | C | N | N | N | N | N | N | N | N | N |
| C | C | C | C | Q | Q | C | N | Q | C | C | C |
| P | N | N | C | N | N | N | N | N | P | N | P |
| C | P | C | N | C | Q | P | N | C | C | P | C |
| Q | Q | Q | Q | Q | Q | Q | N | Q | Q | Q | Q |
| C | N | Q | C | C | N | N | N | C | N | N | C |
| C | C | Q | Q | C | QP | Q | N | C | Q | Q | C |
| C | C | N | Q | Q | Q | Q | N | Q | C | Q | C |
| P | P | C | P | P | QP | P | N | P | P | P | P |
| C | Q | Q | Q | Q | N | C | N | Q | C | Q | C |
| C | C | C | N | C | N | C | N | C | N | C | C |
| C | C | C | N | C | N | C | N | C | C | C | C |
| C | C | N | N | N | C | C | N | C | Q S | C | C |
| N | C | N | N | N | C | C | N | C | Q S | C | C |
| C | C | N | N | N | C | C | N | C | Q S | C | C |
| N | N | QP | N | N | Q | QP | N | N | N | QP | N |
| AARP MedicareRx Saver Plus (PDP) S5921-357 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-046 | Cigna Medicare Rx Secure (PDP) S5617-220 | Cigna-HealthSpring Rx -Reg12 (PDP) S5932-001 | Express Scripts Medicare - Value (PDP) S5660-114 | Humana Preferred Rx Plan (PDP) S5884-106 | SilverScript Basic (PDP) S5601-024 | SmartD Rx Saver (PDP) S0064-012 | United American - Select (PDP) S5755-083 | WellCare Classic (PDP) S5967-149 | Windsor Rx (PDP) S2505-001 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H0408-002 |
| C | Q | Q | Q | Q | Q | C | N | Q | C | Q | C |
| P | QP | QP | Q | P | QP | P | N | P | C | C | P |
| P | QP | QP | Q | P | QP | P | N | P | P | C | P |
| P | QP | QP | Q | P | QP | P | N | P | C | C | P |
| C | N | N | N | N | Q S | N | N | Q | Q | N | C |
| N | N | Q | QP | N | N | Q | N | Q | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N |
| C | Q | Q | Q | Q | Q | N | N | Q | C | Q | C |
| C | C | C | C | C | C | C | N | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N | N |
| QP | Q | Q | QP | C | Q | C | N | C | Q | C | QP |
| 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 | N | N | N | N | N | N |
| P | QP | P | P | P | QP | P | N | P | P | P | P |
| P | P | P | P | P | P | P | N | P | P | P | P |
| P | QP | C | Q S | C | QP | Q | N | P | Q S | Q | P |
| C | N | C | P | P | P | P | N | P | P | N | P |
| C | P | C | P | P | P | P | N | P | P | N | P |
| C | N | C | P | N | N | N | N | N | C | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N |
| QP | N | N | N | N | N | N | N | N | N | N | QP |
| P | N | P | N | P | N | P | N | P | N | P | P |
| C | N | N | N | Q | N | N | N | Q | Q | N | C |
| C S | N | C | Q S | C | Q S | Q | N | C | Q | QP | C S |
| AARP MedicareRx Saver Plus (PDP) S5921-357 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-046 | Cigna Medicare Rx Secure (PDP) S5617-220 | Cigna-HealthSpring Rx -Reg12 (PDP) S5932-001 | Express Scripts Medicare - Value (PDP) S5660-114 | Humana Preferred Rx Plan (PDP) S5884-106 | SilverScript Basic (PDP) S5601-024 | SmartD Rx Saver (PDP) S0064-012 | United American - Select (PDP) S5755-083 | WellCare Classic (PDP) S5967-149 | Windsor Rx (PDP) S2505-001 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H0408-002 |
| P | N | N | P | C | N | N | N | N | N | N | P |
| P | QP | QP | P | QP | C | P | N | QP | P | P | P |
| N | N | N | N | N | N | N | N | N | N | N | N |
| P | QP | N | N | P | N | N | N | P | N | N | P |
| N | N | N | N | N | N | N | N | Q | N | N | N |
| C | C | C | C | C | Q | Q | N | C | Q | QP | C |
| C | Q | Q | Q | Q | Q | Q | N | Q | Q | Q | C |
| N | N | N | Q | Q | N | N | N | Q | N | N | 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 |
| C | Q | Q | Q | Q | Q | Q | N | Q | Q | Q | C |
| N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | C | N | N | N | N | N | N | N |
| C | Q | Q | Q | C | Q | C | N | Q | Q | C | C |
| C | C | C | C | C | Q | Q | N | C | C | Q | C |
| N | N | N | N | N | N | N | N | N | N | N | N |
| C | C | C | C | C | C | C | N | C | C | C | C |
| C | N | C | Q | C | N | QP | N | C | N | QP | C |
| C | C | Q | Q | C | Q | C | N | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N | N |
| N | C | Q | N | N | N | N | N | N | N | N | N |
| C S | N | Q S | C S | C | N | C S | N | C S | C S | C S | C S |
| N | N | N | N | N | N | N | N | N | N | N | N |
| P | P | QP | Q | C | P | P | N | C | P | P | P |
| C | Q | C | Q S | C | N | C | N | C | C | C | C |
| AARP MedicareRx Saver Plus (PDP) S5921-357 | Aetna CVS/pharmacy Prescription Drug Plan (PDP) S5810-046 | Cigna Medicare Rx Secure (PDP) S5617-220 | Cigna-HealthSpring Rx -Reg12 (PDP) S5932-001 | Express Scripts Medicare - Value (PDP) S5660-114 | Humana Preferred Rx Plan (PDP) S5884-106 | SilverScript Basic (PDP) S5601-024 | SmartD Rx Saver (PDP) S0064-012 | United American - Select (PDP) S5755-083 | WellCare Classic (PDP) S5967-149 | Windsor Rx (PDP) S2505-001 | UnitedHealthcare Nursing Home Plan (HMO-POS SNP) H0408-002 |
| 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 | Q | Q | N | N | N | N | N | Q S | Q | N | C |
| P | Q | Q | QP | C | Q | C | N | C | Q | C | P |
| C | N | QP | QP | C | QP | P | N | C | C S | P | C |
| N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | C | N | N | N | Q | N | N | N | Q | N |
| N | N | N | N | N | N | N | N | N | N | N | N |
| C | Q | Q | Q | C | Q | C | N | C | Q | C | C |
| Q | Q | Q | Q | Q | Q | Q | N | Q | Q | Q | Q |
| C | N | C | C | C | N | N | N | C | N | N | C |
| N | N | N | N | N | Q | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N |
| P | QP | Q | P | C | C | C | N | P | QP | C | P |