Key
C | Covered - No restrictions |
Q | Has quantity limits |
S | Has step therapy |
P | Has prior authorization |
N | Not Covered |
| Clear Spring Health Value Rx (PDP) S6946-024 | Wellcare Classic (PDP) S4802-093 | Anthem I Carelon Home Care (HMO I-SNP) H4346-010 |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | P | P |
| N | N | N |
| N | N | N |
| N | Q | Q |
| N | N | N |
| N | P | 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 | Q | Q |
| N | Q | Q |
| N | N | 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 |
| Clear Spring Health Value Rx (PDP) S6946-024 | Wellcare Classic (PDP) S4802-093 | Anthem I Carelon Home Care (HMO I-SNP) H4346-010 |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | QP | QP |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | QP |
| N | N | N |
| N | Q | Q |
| N | C | N |
| N | N | N |
| N | C | C |
| N | N | N |
| N | N | N |
| N | Q | C |
| N | 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 | Q |
| N | C | C |
| N | N | N |
| N | C | C |
| N | Q | Q |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| Clear Spring Health Value Rx (PDP) S6946-024 | Wellcare Classic (PDP) S4802-093 | Anthem I Carelon Home Care (HMO I-SNP) H4346-010 |
| N | N | N |
| Clear Spring Health Value Rx (PDP) S6946-024 | Wellcare Classic (PDP) S4802-093 | Anthem I Carelon Home Care (HMO I-SNP) H4346-010 |
| N | C | Q |
| N | Q | Q S |
| N | N | Q |
| N | N | N |
| N | N | N |
| N | C | C |
| N | N | Q |
| N | N | N |
| N | N | N |
| N | QP | QP |
| N | N | N |
| N | N | N |
| N | N | N |
| N | P | QP |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | C |
| N | N | C |
| N | N | C |
| N | N | N |
| N | N | C |
| N | N | C |
| N | Q | Q |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | Q | Q |
| N | N | N |
| N | N | N |
| N | N | N |
| N | Q | Q |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| Clear Spring Health Value Rx (PDP) S6946-024 | Wellcare Classic (PDP) S4802-093 | Anthem I Carelon Home Care (HMO I-SNP) H4346-010 |
| N | N | C |
| N | N | N |
| N | N | N |
| N | N | N |
| N | Q | QP |
| N | C | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | Q |
| N | C | C |
| N | N | N |
| N | P | QP |
| N | N | N |
| N | N | N |
| N | Q | C |
| N | P | QP |
| 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 | N | N |
| N | N | N |
| N | N | N |
| N | C | C |
| N | N | N |
| N | N | N |
| N | C | N |
| N | N | N |
| Clear Spring Health Value Rx (PDP) S6946-024 | Wellcare Classic (PDP) S4802-093 | Anthem I Carelon Home Care (HMO I-SNP) H4346-010 |
| N | Q | Q |
| N | N | C |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | C | QP |
| N | N | N |
| N | Q | Q |
| N | N | N |
| N | N | N |
| N | Q | C |
| N | N | N |
| N | N | N |
| N | N | QP |
| N | N | N |
| N | Q | Q |
| N | N | N |
| N | N | N |
| N | N | N |
| N | P | P |
| N | P | P |
| N | Q | QP |
| N | P | C |
| N | N | P |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | Q | N |
| N | Q | N |
| N | N | N |
| N | C | P |
| Clear Spring Health Value Rx (PDP) S6946-024 | Wellcare Classic (PDP) S4802-093 | Anthem I Carelon Home Care (HMO I-SNP) H4346-010 |
| N | N | N |
| N | Q | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | Q | Q |
| N | Q | Q |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| N | QP | Q |
| N | Q | Q |
| N | N | N |
| N | N | N |
| N | N | N |
| N | N | N |
| 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 | N | N |
| N | C | C |
| N | N | N |
| Clear Spring Health Value Rx (PDP) S6946-024 | Wellcare Classic (PDP) S4802-093 | Anthem I Carelon Home Care (HMO I-SNP) H4346-010 |
| N | N | N |
| 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 | Q | Q |
| N | N | N |
| N | N | N |
| N | N | C |
| N | N | N |
| N | N | N |
| N | N | N |