Key
C | Covered - No restrictions |
Q | Has quantity limits |
S | Has step therapy |
P | Has prior authorization |
N | Not Covered |
| Cigna Secure Rx (PDP) S5617-225 | Clear Spring Health Value Rx (PDP) S6946-016 | Humana Basic Rx Plan (PDP) S5884-141 | SilverScript Choice (PDP) S5601-038 | Wellcare Classic (PDP) S4802-073 | Tribute Select (HMO-POS I-SNP) H1587-003 |
| N | N | N | N | N | N |
| N | 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 |
| N | N | N | N | N | N |
| N | Q | N | N | Q | C |
| N | Q | N | N | Q | C |
| N | N | N | N | N | N |
| N | C | Q | 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 | P | N | N | N | N |
| N | Q | Q | N | Q | QP |
| N | Q | Q | N | Q | QP |
| N | N | N | N | N | N |
| N | QP | N | N | 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 Secure Rx (PDP) S5617-225 | Clear Spring Health Value Rx (PDP) S6946-016 | Humana Basic Rx Plan (PDP) S5884-141 | SilverScript Choice (PDP) S5601-038 | Wellcare Classic (PDP) S4802-073 | Tribute Select (HMO-POS I-SNP) H1587-003 |
| N | 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 | QP | N | QP | P |
| N | N | N | N | N | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | Q | N |
| N | N | N | N | Q | N |
| N | Q | Q | N | N | C |
| N | C | Q | N | C | C |
| N | N | N | N | N | N |
| N | P | C | N | C | C |
| N | C | C | N | C | C |
| N | N | N | N | N | N |
| N | C | Q | N | Q | C |
| N | N | P | N | N | N |
| N | N | N | N | N | N |
| N | C | N | N | N | N |
| N | QP | QP | N | N | P |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | C | N | N | N | C |
| N | C | C | N | C | C |
| N | N | N | N | N | N |
| N | C | C | N | C | C |
| N | C | Q | N | 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 |
| N | N | N | N | N | N |
| Cigna Secure Rx (PDP) S5617-225 | Clear Spring Health Value Rx (PDP) S6946-016 | Humana Basic Rx Plan (PDP) S5884-141 | SilverScript Choice (PDP) S5601-038 | Wellcare Classic (PDP) S4802-073 | Tribute Select (HMO-POS I-SNP) H1587-003 |
| N | Q | Q | N | C | C |
| N | C | N | N | C S | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | C | Q | N | C | C |
| N | Q | Q | N | N | C |
| N | C | N | N | N | P |
| N | N | N | N | N | C |
| N | QP | Q | N | QP | QP |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | QP | N | P | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | Q S | N | N | N | N |
| N | Q S | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | 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 | P | C |
| N | N | N | N | N | N |
| N | N | N | N | N | C |
| N | N | N | N | N | C |
| N | N | N | N | N | C |
| N | Q | Q | N | Q | Q |
| N | N | N | N | N | N |
| N | Q | Q | N | C | C |
| N | N | N | N | N | N |
| N | Q | Q | N | Q | C |
| N | N | N | N | N | C |
| N | N | N | N | N | N |
| N | N | N | N | N | C |
| N | N | N | N | N | N |
| Cigna Secure Rx (PDP) S5617-225 | Clear Spring Health Value Rx (PDP) S6946-016 | Humana Basic Rx Plan (PDP) S5884-141 | SilverScript Choice (PDP) S5601-038 | Wellcare Classic (PDP) S4802-073 | Tribute Select (HMO-POS I-SNP) H1587-003 |
| N | C | C | N | C | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | P | Q | N | Q | P |
| N | N | C | N | C | N |
| N | C | N | N | N | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | C |
| N | N | Q | N | C | C |
| N | N | N | N | N | N |
| N | P | QP | N | P | P |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | C | Q | N | C | C |
| N | QP | QP | N | P | C |
| N | P | QP | N | N | C |
| N | N | N | N | N | N |
| 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 |
| N | N | Q | N | Q | C |
| N | P | 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 | N | C | C |
| N | C | C | N | C | C |
| N | C | C | N | C | C |
| N | N | N | N | N | N |
| Cigna Secure Rx (PDP) S5617-225 | Clear Spring Health Value Rx (PDP) S6946-016 | Humana Basic Rx Plan (PDP) S5884-141 | SilverScript Choice (PDP) S5601-038 | Wellcare Classic (PDP) S4802-073 | Tribute Select (HMO-POS I-SNP) H1587-003 |
| N | C | Q | N | Q | C |
| N | C | 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 | P | QP | N | C | P |
| N | N | N | N | N | N |
| N | C | Q | N | Q | C |
| N | N | N | N | QP | N |
| N | N | N | N | N | N |
| N | C | Q | N | C | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | QPS | QP | N | N | C |
| N | N | N | N | N | N |
| N | C | Q | N | Q | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | QP | QP | N | P | N |
| N | P | P | N | P | P |
| N | QP | Q | N | Q | C |
| N | P | C | N | P | 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 | N | N | N |
| N | N | N | N | Q | N |
| N | N | N | N | Q | N |
| N | N | N | N | N | N |
| N | Q | Q | N | C | C |
| Cigna Secure Rx (PDP) S5617-225 | Clear Spring Health Value Rx (PDP) S6946-016 | Humana Basic Rx Plan (PDP) S5884-141 | SilverScript Choice (PDP) S5601-038 | Wellcare Classic (PDP) S4802-073 | Tribute Select (HMO-POS I-SNP) H1587-003 |
| N | N | N | N | N | N |
| N | P | P | N | QP | P |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | Q | N | N | N | C |
| N | Q | Q | N | Q | Q |
| N | Q | Q | N | Q | QP |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | C | Q | N | QP | C |
| N | Q | C | N | 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 |
| N | N | N | N | C | N |
| N | Q | C | N | C | C |
| N | N | N | N | N | N |
| N | N | N | N | N | N |
| N | C | 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 | QP | C | N | C | C |
| N | N | N | N | N | N |
| Cigna Secure Rx (PDP) S5617-225 | Clear Spring Health Value Rx (PDP) S6946-016 | Humana Basic Rx Plan (PDP) S5884-141 | SilverScript Choice (PDP) S5601-038 | Wellcare Classic (PDP) S4802-073 | Tribute Select (HMO-POS I-SNP) H1587-003 |
| N | 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 | 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 | Q | C | N | Q | QP |
| N | N | N | N | N | N |
| 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 |