Key
C | Covered - No restrictions |
Q | Has quantity limits |
S | Has step therapy |
P | Has prior authorization |
N | Not Covered |
| Cigna Secure Rx (PDP) S5617-227 | Elixir RxSecure (PDP) S7694-034 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | P | P | P |
| N | N | N | N |
| N | Q | N | Q |
| N | Q | N | Q |
| N | N | N | N |
| N | C | 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 | N | N |
| N | Q | Q | Q |
| N | Q | Q | Q |
| N | N | N | N |
| N | QP | 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 |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Elixir RxSecure (PDP) S7694-034 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | QP | QP | QP |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | Q |
| N | N | N | Q |
| N | Q | Q | N |
| N | C | Q | C |
| N | N | N | N |
| N | C | C | C |
| N | C | C | C |
| N | N | N | N |
| N | Q | Q | Q |
| N | N | P | N |
| N | N | N | N |
| N | N | N | N |
| N | QP | QP | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | Q S | N | N |
| N | P | C | C |
| N | N | N | N |
| N | C | C | C |
| N | Q | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Elixir RxSecure (PDP) S7694-034 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| N | Q | Q | C |
| N | Q | N | C S |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | C | Q | C |
| N | Q | Q | N |
| N | N | N | N |
| N | N | N | N |
| N | Q | Q | QP |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | QP | 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 | N | N | N |
| N | N | N | N |
| N | Q | N | P |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | Q | Q | Q |
| N | N | N | N |
| N | Q | Q | C |
| N | N | N | N |
| N | Q | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Elixir RxSecure (PDP) S7694-034 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| N | C | C | C |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | QP | Q | Q |
| N | N | C | C |
| N | C | N | N |
| N | N | N | N |
| N | N | N | N |
| N | Q | N | N |
| N | C | Q | C |
| N | N | N | N |
| N | P | QP | P |
| N | N | N | N |
| N | N | N | N |
| N | C | Q | C |
| N | Q | QP | P |
| N | Q | 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 | C | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | C | N | C |
| N | C | C | C |
| N | C | C | C |
| N | C | C | C |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Elixir RxSecure (PDP) S7694-034 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| N | Q | Q | Q |
| N | C | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | P | QP | C |
| N | N | N | N |
| N | Q | Q | Q |
| N | N | N | QP |
| N | N | N | N |
| N | Q | Q | C |
| N | N | N | N |
| N | N | N | N |
| N | N | QP | N |
| N | N | N | N |
| N | N | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | QP | QP | P |
| N | P | P | P |
| N | Q | Q | Q |
| N | C | C | P |
| 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 |
| N | N | N | N |
| N | Q | Q | C |
| Cigna Secure Rx (PDP) S5617-227 | Elixir RxSecure (PDP) S7694-034 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| N | N | N | N |
| N | QP | P | QP |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | Q | Q | Q |
| N | Q | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | Q | Q | QP |
| N | C | C | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | C |
| N | Q | C | C |
| 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 | C | C | C |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Elixir RxSecure (PDP) S7694-034 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | C | QP | P |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | Q | C | 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 |