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) S5921-373 | Aetna Medicare Rx Saver (PDP) S5810-063 | Humana Preferred Rx Plan (PDP) S5884-112 | Symphonix Rite Aid Value Rx (PDP) S0522-045 |
| Q | Q | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| P | P | P | P |
| N | N | N | N |
| Q | Q | N | Q |
| C | Q | N | Q |
| C | Q | N | Q |
| P | P | P | P |
| C | Q | Q | C |
| N | N | N | N |
| N | N | N | N |
| Q | Q | N | Q |
| C | C | Q | Q |
| N | N | N | N |
| P | QP | N | QP |
| Q | Q | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| C | N | N | N |
| C | N | N | N |
| C | N | N | N |
| AARP MedicareRx Saver Plus (PDP) S5921-373 | Aetna Medicare Rx Saver (PDP) S5810-063 | Humana Preferred Rx Plan (PDP) S5884-112 | Symphonix Rite Aid Value Rx (PDP) S0522-045 |
| C | P | P | C |
| Q | N | Q | Q |
| Q | N | Q | Q |
| N | N | N | P |
| N | N | N | C |
| N | N | N | N |
| P | N | N | N |
| Q | N | N | Q S |
| C | N | N | N |
| C | C | C | Q |
| N | Q | Q | Q |
| N | C | N | N |
| C | C | C | C |
| C | C | C | C |
| N | N | N | N |
| N | Q | N | N |
| P | P | P | P |
| C | Q | Q | QP |
| C | C | Q | Q |
| P | QP | QP | QP |
| N | N | N | N |
| C | C | C | C |
| C | P | C | C |
| C | Q | Q | C |
| N | N | N | N |
| C S | Q S | C | C S |
| N | N | N | N |
| Q | C | Q | Q |
| P | N | QP | N |
| AARP MedicareRx Saver Plus (PDP) S5921-373 | Aetna Medicare Rx Saver (PDP) S5810-063 | Humana Preferred Rx Plan (PDP) S5884-112 | Symphonix Rite Aid Value Rx (PDP) S0522-045 |
| C | Q | Q | Q |
| C | C | N | Q |
| N | N | N | N |
| N | N | N | N |
| Q S | Q | Q | C |
| N | C | Q | N |
| Q | Q | Q | Q |
| N | N | N | N |
| N | N | N | N |
| C | N | N | N |
| P | QP | Q S | P |
| C | C | N | N |
| C | N | Q | N |
| C | C | C | C |
| N | N | C | C |
| N | N | N | N |
| N | N | C | C |
| N | N | C | C |
| N | N | C | C |
| N | N | C | C |
| N | N | N | N |
| N | N | N | N |
| Q | Q S | Q S | C |
| N | N | N | N |
| P | P | QP | QP |
| N | N | N | N |
| Q | Q | Q | Q |
| N | N | N | N |
| N | N | N | N |
| AARP MedicareRx Saver Plus (PDP) S5921-373 | Aetna Medicare Rx Saver (PDP) S5810-063 | Humana Preferred Rx Plan (PDP) S5884-112 | Symphonix Rite Aid Value Rx (PDP) S0522-045 |
| C | C | C | C |
| N | N | N | N |
| N | N | N | N |
| QP | N | N | N |
| QP | QP | C | P |
| C | N | C | C |
| N | Q | N | Q |
| N | N | N | N |
| C | C | Q | C |
| N | N | N | N |
| P | P | QP | Q |
| C | N | N | P |
| N | N | N | N |
| C | C | Q | Q |
| P | C | N | C |
| C | P | Q | C |
| Q | Q | Q | Q |
| C | N | N | C |
| P | QP | QP | QP |
| C | N | N | Q |
| P | P | QP | P |
| C | N | Q | Q |
| N | N | N | C |
| C | N | N | C |
| C | C | C | N |
| C | C | C | N |
| C | C | C | N |
| N | N | QP | N |
| AARP MedicareRx Saver Plus (PDP) S5921-373 | Aetna Medicare Rx Saver (PDP) S5810-063 | Humana Preferred Rx Plan (PDP) S5884-112 | Symphonix Rite Aid Value Rx (PDP) S0522-045 |
| C | Q | Q | Q |
| C | Q | Q | Q |
| P | P | QP | P |
| P | QP | QP | P |
| P | P | QP | P |
| N | N | Q | Q |
| N | N | N | N |
| N | N | N | N |
| C | Q | Q | Q |
| C | C | C | C |
| N | N | N | N |
| QP | Q | Q | C |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| P | QP | QP | QP |
| P | P | P | P |
| P | QP | P | QP |
| C | P | N | P |
| C | P | P | P |
| C | N | N | N |
| N | N | N | N |
| QP | N | N | N |
| P | N | N | P |
| C | N | N | N |
| Q | N | Q S | Q |
| AARP MedicareRx Saver Plus (PDP) S5921-373 | Aetna Medicare Rx Saver (PDP) S5810-063 | Humana Preferred Rx Plan (PDP) S5884-112 | Symphonix Rite Aid Value Rx (PDP) S0522-045 |
| P | N | N | C |
| P | QP | C | N |
| N | N | N | N |
| QP | N | QP | QP |
| N | N | N | N |
| N | Q | Q | N |
| C | C | Q | Q |
| C | Q | Q | C |
| N | Q | N | Q |
| N | N | N | N |
| N | N | N | N |
| Q | Q | Q | Q |
| N | N | N | N |
| N | N | N | N |
| Q | Q | Q | Q |
| C | C | Q | Q |
| C | C | N | C |
| C | C | C | C |
| C | C | QP | Q |
| C | C | Q | C |
| N | N | N | N |
| N | N | N | N |
| C S | N | N | C S |
| N | N | N | N |
| P | P | C | P |
| P | Q | C | C |
| AARP MedicareRx Saver Plus (PDP) S5921-373 | Aetna Medicare Rx Saver (PDP) S5810-063 | Humana Preferred Rx Plan (PDP) S5884-112 | Symphonix Rite Aid Value Rx (PDP) S0522-045 |
| N | N | N | N |
| N | N | N | N |
| Q | N | N | N |
| QP | Q | Q | C |
| P | N | QP | C |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| C | Q | Q | Q |
| Q | Q | Q | C |
| Q | QP | Q | Q |
| N | N | N | Q |
| C | N | N | C |
| N | N | N | N |
| N | N | N | N |
| QP | QP | C | P |