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) S5921-360 | Cigna Secure Rx (PDP) S5617-222 | Clear Spring Health Value Rx (PDP) S6946-012 | Elixir RxSecure (PDP) S7694-015 | Express Scripts Medicare - Value (PDP) S5660-117 | Humana Basic Rx Plan (PDP) S5884-138 | SilverScript Choice (PDP) S5601-030 | WellCare Classic (PDP) S4802-086 | Signature Advantage Community (HMO I-SNP) H2400-002 | Signature Advantage Plan (HMO I-SNP) H2400-001 |
| 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 | N | N | N | N | N | N | N | N |
| P | P | N | P | P | C | P | P | P | P |
| N | N | N | N | N | N | N | N | N | N |
| N | Q | N | Q | Q | N | Q | Q | C | C |
| N | Q | N | Q | Q | N | Q | Q | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | C | N | C | C | Q | C | C | C | C |
| 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 |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| P | P | N | N | P | N | N | N | N | N |
| Q | Q | N | Q | Q | Q | Q | Q | Q | Q |
| Q | Q | N | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N | N | N |
| QP | N | N | QP | N | 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 | 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 | N | N | N | N | N | N | N |
| AARP MedicareRx Saver Plus (PDP) S5921-360 | Cigna Secure Rx (PDP) S5617-222 | Clear Spring Health Value Rx (PDP) S6946-012 | Elixir RxSecure (PDP) S7694-015 | Express Scripts Medicare - Value (PDP) S5660-117 | Humana Basic Rx Plan (PDP) S5884-138 | SilverScript Choice (PDP) S5601-030 | WellCare Classic (PDP) S4802-086 | Signature Advantage Community (HMO I-SNP) H2400-002 | Signature Advantage Plan (HMO I-SNP) H2400-001 |
| 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 | QP | N | P | QP | QP | QP | QP | P | P |
| 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 | N | N |
| N | N | N | N | N | N | Q | Q | N | N |
| N | C | N | C | C | Q | Q | Q | C | C |
| N | Q | N | Q | Q | Q | N | N | C | C |
| C | N | N | C | N | Q | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| C | P | N | C | P | C | C | C | C | C |
| C | C | N | C | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | Q | N | C | Q | Q | Q | Q | C | C |
| N | N | N | N | N | P | N | N | N | N |
| C | C | N | C | C | Q | P | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | QP | N | P | QP | QP | QP | N | 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 |
| N | N | N | C | N | N | N | N | C | C |
| P | C | N | P | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| C | C | N | C | C | C | C | C | C | C |
| Q | Q | N | C | Q | Q | Q | Q | 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 |
| 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) S5921-360 | Cigna Secure Rx (PDP) S5617-222 | Clear Spring Health Value Rx (PDP) S6946-012 | Elixir RxSecure (PDP) S7694-015 | Express Scripts Medicare - Value (PDP) S5660-117 | Humana Basic Rx Plan (PDP) S5884-138 | SilverScript Choice (PDP) S5601-030 | WellCare Classic (PDP) S4802-086 | Signature Advantage Community (HMO I-SNP) H2400-002 | Signature Advantage Plan (HMO I-SNP) H2400-001 |
| C | Q | N | Q | Q | Q | Q | C | C | C |
| N | N | N | C | Q | Q | N | C S | 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 | Q | N | N | N |
| Q | Q | N | C | Q | Q | C | C | C | C |
| N | N | N | C | N | Q | N | N | C | C |
| C S | C S | N | N | C S | N | N | N | P | P |
| N | C | N | N | C | N | N | N | C | C |
| Q | Q | N | Q | QP | Q | 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 | QP | P | P | P | P |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | C | C |
| C | N | N | N | N | N | Q | N | N | N |
| C | N | N | N | N | N | Q | N | N | N |
| C | C | N | N | C | N | N | N | N | N |
| C | C | N | N | C | N | N | N | N | N |
| C | C | N | N | C | N | N | N | N | N |
| C | C | N | N | C | N | N | N | N | N |
| C | C | N | N | C | N | N | N | N | N |
| C | C | N | N | C | N | N | N | N | N |
| Q | Q | N | Q | Q | N | Q | P | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | C | C |
| N | N | N | N | N | N | N | N | C | C |
| N | N | N | N | N | N | N | N | C | C |
| C | C | N | C | Q | Q | Q | Q | C S | C S |
| N | N | N | N | N | N | N | N | N | N |
| C | Q | N | Q | Q | Q | Q | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| Q | Q | N | Q | Q | Q | Q | Q | 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 |
| AARP MedicareRx Saver Plus (PDP) S5921-360 | Cigna Secure Rx (PDP) S5617-222 | Clear Spring Health Value Rx (PDP) S6946-012 | Elixir RxSecure (PDP) S7694-015 | Express Scripts Medicare - Value (PDP) S5660-117 | Humana Basic Rx Plan (PDP) S5884-138 | SilverScript Choice (PDP) S5601-030 | WellCare Classic (PDP) S4802-086 | Signature Advantage Community (HMO I-SNP) H2400-002 | Signature Advantage Plan (HMO I-SNP) H2400-001 |
| N | C | N | C | N | C | C | C | 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 |
| Q | QP | N | P | QP | Q | QP | Q | C | C |
| N | C | N | N | C | C | 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 | N | N |
| N | N | N | Q | N | N | N | N | C | C |
| N | C | N | C | C | Q | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| P | P | N | P | P | QP | P | P | P | P |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| C | Q | N | C | Q | Q | C | C | C | C |
| QP | QP | N | Q | QP | QP | QP | P | C | C |
| P | QP | N | C | QP | QP | 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 | 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 |
| N | N | N | N | N | 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 |
| C | N | N | C | C | N | C | C | C | C |
| N | N | N | C | N | C | C | C | C | C |
| N | N | N | C | N | C | C | C | C | C |
| N | N | N | C | N | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| AARP MedicareRx Saver Plus (PDP) S5921-360 | Cigna Secure Rx (PDP) S5617-222 | Clear Spring Health Value Rx (PDP) S6946-012 | Elixir RxSecure (PDP) S7694-015 | Express Scripts Medicare - Value (PDP) S5660-117 | Humana Basic Rx Plan (PDP) S5884-138 | SilverScript Choice (PDP) S5601-030 | WellCare Classic (PDP) S4802-086 | Signature Advantage Community (HMO I-SNP) H2400-002 | Signature Advantage Plan (HMO I-SNP) H2400-001 |
| N | C | N | C | C | Q | Q | Q | C | C |
| N | N | N | C | 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 |
| P | P | N | P | P | QP | P | C | QP | QP |
| P | P | N | P | P | QP | P | C | QP | QP |
| Q | N | N | N | N | N | N | N | N | N |
| Q | C | N | C | Q | Q | Q | Q | C | C |
| N | N | N | N | N | N | QP | QP | N | N |
| N | N | N | N | N | N | N | N | N | N |
| Q | Q | N | C | Q | Q | Q | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| Q S | N | N | C S | N | Q | N | N | C | C |
| N | N | N | N | N | N | N | N | N | N |
| Q | N | N | N | N | 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 | N | N |
| P | P | N | QP | P | N | P | P | N | N |
| P | P | N | P | P | P | P | P | P | P |
| Q | Q | N | Q | Q | Q | Q | Q | C | C |
| C | P | N | C | N | C | P | P | C | C |
| C | N | N | N | N | N | N | N | 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 | N | N |
| N | N | N | N | N | N | N | N | N | N |
| Q | N | N | N | N | N | Q | Q | N | N |
| Q | N | N | N | N | N | Q | Q | N | N |
| N | N | N | N | N | N | N | N | N | N |
| Q | Q | N | Q | Q | Q | C | C | C | C |
| AARP MedicareRx Saver Plus (PDP) S5921-360 | Cigna Secure Rx (PDP) S5617-222 | Clear Spring Health Value Rx (PDP) S6946-012 | Elixir RxSecure (PDP) S7694-015 | Express Scripts Medicare - Value (PDP) S5660-117 | Humana Basic Rx Plan (PDP) S5884-138 | SilverScript Choice (PDP) S5601-030 | WellCare Classic (PDP) S4802-086 | Signature Advantage Community (HMO I-SNP) H2400-002 | Signature Advantage Plan (HMO I-SNP) H2400-001 |
| N | N | N | N | N | N | N | N | N | N |
| P | P | N | P | P | P | QP | QP | 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 |
| N | N | N | Q | N | N | N | N | C | C |
| C | C | N | C | Q | Q | Q | Q | C S | C S |
| C | Q | N | Q | Q | Q | Q | Q | 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 | Q | N | C | Q | Q | QP | QP | C | C |
| Q | Q | N | C | Q | C | Q | Q | 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 |
| N | N | N | N | N | N | N | N | N | N |
| C | P | N | N | P | N | C | C | N | N |
| C | C | N | C | C | C | C | C | C | C |
| C | N | N | C | N | N | N | N | C | C |
| N | N | N | N | N | N | N | N | N | N |
| N | C | N | C | C | 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 |
| N | N | N | N | N | N | N | N | N | N |
| C | C | N | C | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| AARP MedicareRx Saver Plus (PDP) S5921-360 | Cigna Secure Rx (PDP) S5617-222 | Clear Spring Health Value Rx (PDP) S6946-012 | Elixir RxSecure (PDP) S7694-015 | Express Scripts Medicare - Value (PDP) S5660-117 | Humana Basic Rx Plan (PDP) S5884-138 | SilverScript Choice (PDP) S5601-030 | WellCare Classic (PDP) S4802-086 | Signature Advantage Community (HMO I-SNP) H2400-002 | Signature Advantage Plan (HMO I-SNP) H2400-001 |
| 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 |
| P | QP | N | C | QP | QP | P | P | 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 |
| N | N | N | N | N | N | N | N | N | N |
| Q | Q | N | Q | Q | C | Q | 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 | 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 |