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 | Clear Spring Health Value Rx (PDP) S6946-029 | 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 |
| P | N | P | P |
| N | N | N | N |
| N | N | N | N |
| Q | N | N | Q |
| N | N | N | N |
| P | 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 |
| P | N | N | N |
| Q | N | Q | Q |
| Q | N | Q | Q |
| 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 |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Clear Spring Health Value Rx (PDP) S6946-029 | 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 |
| QP | N | QP | QP |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| Q | N | Q | Q |
| N | N | Q | C |
| N | N | N | N |
| P | N | C | C |
| N | N | N | N |
| N | N | N | N |
| Q | N | Q | Q |
| 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 | Q | Q |
| N | N | N | N |
| N | N | N | N |
| C | N | C | C |
| N | N | N | N |
| C | N | C | C |
| Q | N | 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 | Clear Spring Health Value Rx (PDP) S6946-029 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Clear Spring Health Value Rx (PDP) S6946-029 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| Q | N | Q | C |
| N | N | N | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| Q | N | Q | C |
| Q | N | Q | N |
| C S | N | N | N |
| C | N | N | N |
| Q | N | Q | QP |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| QP | N | QP | P |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| C | N | N | N |
| C | N | N | N |
| C | N | N | N |
| N | N | N | N |
| C | N | N | N |
| C | N | N | N |
| Q | N | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| Q | N | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| Q | N | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Clear Spring Health Value Rx (PDP) S6946-029 | 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 |
| QP | N | Q | Q |
| C | N | C | C |
| C | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | Q | N |
| C | N | Q | C |
| N | N | N | N |
| P | N | QP | P |
| N | N | N | N |
| N | N | N | N |
| C | N | Q | Q |
| QP | N | QP | P |
| 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 | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | C |
| N | N | C | N |
| N | N | C | N |
| N | N | C | C |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Clear Spring Health Value Rx (PDP) S6946-029 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| C | N | Q | Q |
| N | N | Q | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| P | N | P | C |
| N | N | N | N |
| C | N | Q | Q |
| N | N | N | N |
| N | N | N | N |
| Q | N | Q | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | QP | N |
| N | N | N | N |
| N | N | N | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| P | N | QP | P |
| P | N | P | P |
| Q | N | Q | Q |
| P | N | 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 |
| Q | N | Q | C |
| Cigna Secure Rx (PDP) S5617-227 | Clear Spring Health Value Rx (PDP) S6946-029 | Humana Basic Rx Plan (PDP) S5884-116 | Wellcare Classic (PDP) S4802-096 |
| N | N | N | N |
| P | N | N | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| Q | N | Q | Q |
| Q | N | Q S | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | Q | N |
| Q | N | Q | QP |
| Q | N | C | Q |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| P | 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 | N | N |
| N | N | N | N |
| C | N | C | C |
| N | N | N | N |
| Cigna Secure Rx (PDP) S5617-227 | Clear Spring Health Value Rx (PDP) S6946-029 | 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 |
| QP | N | QP | QP |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| N | N | N | N |
| Q | N | 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 |