Key
C | Covered - No restrictions |
Q | Has quantity limits |
S | Has step therapy |
P | Has prior authorization |
N | Not Covered |
| Cigna-HealthSpring Rx Secure (PDP) S5617-218 | Clear Spring Health Value Rx (PDP) S6946-006 | EnvisionRxSecure (PDP) S7694-009 | SilverScript Choice (PDP) S5601-018 | WellCare Medicare Rx Saver (PDP) S5810-043 | PruittHealth Premier (HMO I-SNP) H6345-002 |
| 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 | N | N | N | N | N |
| P | P | P | P | P | P |
| N | N | N | N | N | N |
| Q | Q | Q | Q | Q | N |
| Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N |
| C | C | C | C | C | C |
| N | N | N | N | C | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| Q | Q | Q | Q | Q | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| QP | N | N | N | N | PS |
| Q | Q | Q | Q | Q | P |
| Q | Q | Q | Q | Q | QP |
| N | N | N | N | N | N |
| QP | QP | QP | QP | QP | 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 |
| N | N | N | N | N | N |
| Cigna-HealthSpring Rx Secure (PDP) S5617-218 | Clear Spring Health Value Rx (PDP) S6946-006 | EnvisionRxSecure (PDP) S7694-009 | SilverScript Choice (PDP) S5601-018 | WellCare Medicare Rx Saver (PDP) S5810-043 | PruittHealth Premier (HMO I-SNP) H6345-002 |
| N | N | N | N | N | N |
| P | P | P | P | P | P |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| QP | QP | QP | QP | QP | N |
| N | N | N | N | N | Q |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | Q | Q | N |
| C | C | C | Q | Q | C |
| Q | Q | Q | N | C | N |
| N | C | C | C | C | C |
| C | C | C | C | C | C |
| C | C | C | C | C | C |
| C | C | C | C | C | C |
| N | N | N | N | N | N |
| Q | C | C | Q | Q | Q |
| N | N | N | N | N | N |
| C | C | C | P | C | C |
| N | N | N | Q | Q | N |
| QP | QP | QP | QP | 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 | N |
| P | P | P | C | C | P |
| N | N | N | N | N | N |
| C | C | C | C | C | C |
| Q | C | C | Q | Q | Q |
| 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 |
| Cigna-HealthSpring Rx Secure (PDP) S5617-218 | Clear Spring Health Value Rx (PDP) S6946-006 | EnvisionRxSecure (PDP) S7694-009 | SilverScript Choice (PDP) S5601-018 | WellCare Medicare Rx Saver (PDP) S5810-043 | PruittHealth Premier (HMO I-SNP) H6345-002 |
| Q | Q | Q | C | C | C |
| N | C | C | N | C S | C |
| N | N | N | N | N | Q |
| N | N | N | N | N | N |
| N | N | N | Q | N | N |
| Q | C | C | C | C | Q |
| N | C | C | N | N | N |
| Q S | C | N | N | N | C S |
| Q | N | N | N | C | C |
| Q | Q | Q | QP | QP | Q |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| QP | N | N | P | P | C |
| N | N | N | N | N | C |
| N | N | N | N | N | C |
| Q | N | N | Q | Q | C |
| Q | N | N | Q | Q | C |
| C | N | N | N | N | N |
| C | N | N | N | N | N |
| C | N | N | N | N | N |
| C | N | N | N | N | N |
| C | N | N | N | N | N |
| C | N | N | N | N | N |
| Q | Q | Q | P | P | Q |
| N | N | N | N | N | N |
| N | C | N | N | N | N |
| N | C | N | N | N | N |
| N | C | N | N | N | N |
| Q | Q S | Q S | Q | Q | P |
| N | N | N | N | N | N |
| QP | QP | QP | P | P | P |
| N | N | N | N | N | N |
| Q | Q | Q | C | C | C |
| N | N | N | Q | C | C |
| N | N | N | Q | C | C |
| N | N | N | N | N | N |
| Cigna-HealthSpring Rx Secure (PDP) S5617-218 | Clear Spring Health Value Rx (PDP) S6946-006 | EnvisionRxSecure (PDP) S7694-009 | SilverScript Choice (PDP) S5601-018 | WellCare Medicare Rx Saver (PDP) S5810-043 | PruittHealth Premier (HMO I-SNP) H6345-002 |
| C | C | C | C | C | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| Q | P | P | C | C | P |
| C | C | C | C | C | C |
| N | C | C | C | C | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| C | C | C | C | C | Q |
| N | N | N | N | N | N |
| QP | P | P | P | P | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| C | C | C | C | C | C |
| QP | Q | Q | P | P | C |
| QP | C | C | N | N | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | QP | QP | N | N | N |
| N | N | N | N | N | C |
| N | N | N | N | N | N |
| N | C | C | C | C | C |
| N | C | C | C | C | C |
| N | C | C | C | C | C |
| N | C | C | C | C | C |
| N | N | N | N | N | N |
| Cigna-HealthSpring Rx Secure (PDP) S5617-218 | Clear Spring Health Value Rx (PDP) S6946-006 | EnvisionRxSecure (PDP) S7694-009 | SilverScript Choice (PDP) S5601-018 | WellCare Medicare Rx Saver (PDP) S5810-043 | PruittHealth Premier (HMO I-SNP) H6345-002 |
| C | C | C | C | C | C |
| N | C | C | N | P | C |
| Q | C | C | C | C | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| P | P | P | P | C | P |
| P | P | P | P | C | P |
| N | N | N | N | N | N |
| C | Q | Q | Q | Q | Q |
| N | N | N | QP | N | N |
| N | N | N | N | N | N |
| Q | C | C | C | C | C |
| N | N | N | N | N | N |
| N | C S | C S | N | N | C |
| N | N | N | N | N | N |
| Q | N | N | Q | Q | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | QP | QP | P | P | N |
| P | P | P | P | P | P |
| Q | Q | Q | Q | Q | P |
| P | C | C | P | P | C |
| N | N | N | N | N | C |
| 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 | Q | Q | N |
| N | N | N | Q | Q | N |
| N | N | N | N | N | N |
| Q | Q | Q | C | C | C |
| Cigna-HealthSpring Rx Secure (PDP) S5617-218 | Clear Spring Health Value Rx (PDP) S6946-006 | EnvisionRxSecure (PDP) S7694-009 | SilverScript Choice (PDP) S5601-018 | WellCare Medicare Rx Saver (PDP) S5810-043 | PruittHealth Premier (HMO I-SNP) H6345-002 |
| N | N | N | N | N | N |
| P | P | P | QP | QP | Q |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | Q | Q | N | C | C |
| Q | C | C | Q | Q | P |
| Q | Q | Q | Q | Q | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| Q | C | C | QP | QP | C |
| Q | C | C | Q | Q | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| Q | C | C | C | C | C |
| C | N | N | C | C | C |
| C | C | C | C | C | C |
| N | C | C | N | N | Q |
| N | N | N | C | C | Q |
| C | C | C | N | N | Q |
| 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 | C | C | C | C |
| N | N | N | N | N | N |
| Cigna-HealthSpring Rx Secure (PDP) S5617-218 | Clear Spring Health Value Rx (PDP) S6946-006 | EnvisionRxSecure (PDP) S7694-009 | SilverScript Choice (PDP) S5601-018 | WellCare Medicare Rx Saver (PDP) S5810-043 | PruittHealth Premier (HMO I-SNP) H6345-002 |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| QP | C | C | P | P | QP |
| N | N | N | N | N | N |
| N | N | N | Q | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| Q | Q | Q | Q | Q | C |
| Q | Q | Q | QP | QP | Q |
| N | 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 |