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) S6946-008 | Wellcare Classic (PDP) S4802-083 | American Health Advantage of Florida (HMO I-SNP) H6652-001 | Florida Complete Care (HMO I-SNP) H9986-001 | Florida Complete Care- In The Community (HMO I-SNP) H9986-002 | Longevity Health Plan (HMO I-SNP) H1644-001 | Premier Care (HMO I-SNP) H9917-004 | Senior Care (HMO I-SNP) H9917-001 | Simply Comfort (HMO I-SNP) H5471-068 | UHC Care Advantage FL-E001 (PPO I-SNP) H0710-012 | UHC Nursing Home Plan EX-F001 (PPO I-SNP) H0710-004 | UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP) H5322-003 | UHC Nursing Home Plan FL-F001 (PPO I-SNP) H0710-010 | UHC Nursing Home Plan FL-F002 (PPO I-SNP) H0710-038 |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | 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 | P | P | P | P | P | P | P | P | P | P | P |
| 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 | Q | Q | Q |
| N | Q | C | Q | Q | Q | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | P | P | P | P | P | P | P | QP | P | P | P | 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 | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | 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 | C S | N | N | N | N | N |
| N | N | N | N | N | P | N | N | P | P | P | P | P | P |
| N | N | P | N | N | QP | QP | QP | QP | QP | QP | QP | QP | QP |
| N | Q | C | Q | Q | Q | C | C | Q | Q | Q | Q | Q | Q |
| N | Q | C | Q | Q | Q | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | QP | QP | QP | QP | QP | QP | QP | QP | QP | 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 |
| N | N | N | N | N | N | N | 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) S6946-008 | Wellcare Classic (PDP) S4802-083 | American Health Advantage of Florida (HMO I-SNP) H6652-001 | Florida Complete Care (HMO I-SNP) H9986-001 | Florida Complete Care- In The Community (HMO I-SNP) H9986-002 | Longevity Health Plan (HMO I-SNP) H1644-001 | Premier Care (HMO I-SNP) H9917-004 | Senior Care (HMO I-SNP) H9917-001 | Simply Comfort (HMO I-SNP) H5471-068 | UHC Care Advantage FL-E001 (PPO I-SNP) H0710-012 | UHC Nursing Home Plan EX-F001 (PPO I-SNP) H0710-004 | UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP) H5322-003 | UHC Nursing Home Plan FL-F001 (PPO I-SNP) H0710-010 | UHC Nursing Home Plan FL-F002 (PPO I-SNP) H0710-038 |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | 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 | QP | QP | QP | C | C | QP | Q | Q | Q | Q | Q |
| N | N | C | N | N | N | Q | 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 |
| N | N | N | QP | QP | QP | N | N | QP | QP | QP | QP | QP | QP |
| N | N | N | N | N | C | N | N | N | N | N | N | N | N |
| N | Q | C | Q | Q | C | C | C | Q | Q | Q | Q | Q | Q |
| N | C | C | C | C | C | C | C | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | C | C | C | C | C | C | C | C | 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 | Q | C | Q | Q | C | C | C | C | Q | 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 |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | P | 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 | N | N | N | N | N |
| N | Q | C | Q | Q | C | C | C | Q | 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 | C | C | Q | N | N | N | N | N |
| N | C | C | C | C | C | P | P | C | P | P | P | P | P |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | C | C | C | C | C | C | C | C | C | C | C | C | C |
| N | Q | C | Q | Q | C | Q | Q | Q | Q | 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 |
| N | N | N | N | N | N | N | N | N | N | N | N | 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 |
| Clear Spring Health Value Rx (PDP) S6946-008 | Wellcare Classic (PDP) S4802-083 | American Health Advantage of Florida (HMO I-SNP) H6652-001 | Florida Complete Care (HMO I-SNP) H9986-001 | Florida Complete Care- In The Community (HMO I-SNP) H9986-002 | Longevity Health Plan (HMO I-SNP) H1644-001 | Premier Care (HMO I-SNP) H9917-004 | Senior Care (HMO I-SNP) H9917-001 | Simply Comfort (HMO I-SNP) H5471-068 | UHC Care Advantage FL-E001 (PPO I-SNP) H0710-012 | UHC Nursing Home Plan EX-F001 (PPO I-SNP) H0710-004 | UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP) H5322-003 | UHC Nursing Home Plan FL-F001 (PPO I-SNP) H0710-010 | UHC Nursing Home Plan FL-F002 (PPO I-SNP) H0710-038 |
| N | N | C | N | N | C | C | C | C | C | C | C | C | C |
| Clear Spring Health Value Rx (PDP) S6946-008 | Wellcare Classic (PDP) S4802-083 | American Health Advantage of Florida (HMO I-SNP) H6652-001 | Florida Complete Care (HMO I-SNP) H9986-001 | Florida Complete Care- In The Community (HMO I-SNP) H9986-002 | Longevity Health Plan (HMO I-SNP) H1644-001 | Premier Care (HMO I-SNP) H9917-004 | Senior Care (HMO I-SNP) H9917-001 | Simply Comfort (HMO I-SNP) H5471-068 | UHC Care Advantage FL-E001 (PPO I-SNP) H0710-012 | UHC Nursing Home Plan EX-F001 (PPO I-SNP) H0710-004 | UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP) H5322-003 | UHC Nursing Home Plan FL-F001 (PPO I-SNP) H0710-010 | UHC Nursing Home Plan FL-F002 (PPO I-SNP) H0710-038 |
| N | C | C | C | C | Q | C | C | Q | C | C | C | C | C |
| N | Q | C | Q S | Q S | Q | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | Q | QP | QP | N | Q | Q | Q | Q | 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 |
| N | C | C | C | C | C | Q | Q | C | Q | Q | Q | Q | Q |
| N | N | C | Q | Q | Q | C | C | Q | Q | Q | Q | Q | Q |
| N | N | C | N | N | C | C S | C S | C S | C S | C S | C S | C S | C S |
| N | N | C | N | N | C | C | C | C | C | C | C | C | C |
| N | QP | QP | QP | QP | QP | Q | Q | QP | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | 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 | N | N | N | N | N | N | N |
| N | P | N | N | N | QP | N | N | QP | QP | QP | QP | QP | QP |
| N | N | N | N | N | N | 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 | C | 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 | C | C | C | C | C | C | C | C | C |
| N | N | N | N | N | C S | C | C | C | C | C | C | C | C |
| N | N | N | N | N | C | C | C | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | C | C | C | C | C | C | C | C | C |
| N | N | N | N | N | C | C | C | C | C | C | C | C | C |
| N | Q | C | P | P | Q | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | C | N | N | N | N | N | C | N | N | N | N | N |
| N | N | C | N | N | N | N | N | C | N | N | N | N | N |
| N | N | C | N | N | N | N | N | C | N | N | N | N | N |
| N | Q | C | Q | Q | Q | QP | QP | Q | 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 | N | N | N | N | N | N | N | N | N | N | N | N |
| N | Q | C | Q | Q | C | C | C | Q | Q | 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 |
| N | N | N | 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 |
| Clear Spring Health Value Rx (PDP) S6946-008 | Wellcare Classic (PDP) S4802-083 | American Health Advantage of Florida (HMO I-SNP) H6652-001 | Florida Complete Care (HMO I-SNP) H9986-001 | Florida Complete Care- In The Community (HMO I-SNP) H9986-002 | Longevity Health Plan (HMO I-SNP) H1644-001 | Premier Care (HMO I-SNP) H9917-004 | Senior Care (HMO I-SNP) H9917-001 | Simply Comfort (HMO I-SNP) H5471-068 | UHC Care Advantage FL-E001 (PPO I-SNP) H0710-012 | UHC Nursing Home Plan EX-F001 (PPO I-SNP) H0710-004 | UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP) H5322-003 | UHC Nursing Home Plan FL-F001 (PPO I-SNP) H0710-010 | UHC Nursing Home Plan FL-F002 (PPO I-SNP) H0710-038 |
| N | N | C | N | N | C S | C | C | C | 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 | N | N | N | N | N | N | N | N | N | N | N | N |
| N | Q | C | Q | Q | C | Q | Q | QP | Q | Q | Q | Q | Q |
| N | C | N | C | C | C | N | N | N | C | C | C | C | C |
| N | N | C | N | N | C | C | 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 | C | N | N | Q | Q | Q | Q | Q | Q | Q | Q | Q |
| N | C | C | C | C | C | Q | Q | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | P | P | P | P | P | Q | Q | QP | QP | 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 | Q | C | C | C | Q | C | C | C | C | C | C | C | C |
| N | P | C | P | P | P | C | C | QP | QP | QP | QP | QP | QP |
| N | N | C | P | P | P | C | C | QP | QP | 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 | C | 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 | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | Q | C | Q | Q | C | C | C | C | Q | Q | Q | Q | Q |
| N | N | N | N | N | P | N | N | 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 | C | C | C | C | C | C | C | C | C | C | C | C | C |
| N | N | C | N | N | N | N | N | C | N | N | N | N | N |
| N | N | C | N | N | N | N | N | C | N | N | N | N | N |
| N | C | C | C | C | N | N | N | C | 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) S6946-008 | Wellcare Classic (PDP) S4802-083 | American Health Advantage of Florida (HMO I-SNP) H6652-001 | Florida Complete Care (HMO I-SNP) H9986-001 | Florida Complete Care- In The Community (HMO I-SNP) H9986-002 | Longevity Health Plan (HMO I-SNP) H1644-001 | Premier Care (HMO I-SNP) H9917-004 | Senior Care (HMO I-SNP) H9917-001 | Simply Comfort (HMO I-SNP) H5471-068 | UHC Care Advantage FL-E001 (PPO I-SNP) H0710-012 | UHC Nursing Home Plan EX-F001 (PPO I-SNP) H0710-004 | UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP) H5322-003 | UHC Nursing Home Plan FL-F001 (PPO I-SNP) H0710-010 | UHC Nursing Home Plan FL-F002 (PPO I-SNP) H0710-038 |
| N | Q | C | Q | Q | C | C | C | Q | Q | Q | Q | Q | Q |
| N | N | C | P | P | C | C | C | C | Q | 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 |
| N | N | N | N | N | 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 | P | P | P | P | P | QP | QP | QP | QP | QP | QP |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | Q | C | Q | Q | C | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | Q | Q | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | Q | C | C | C | Q | C | C | C | Q | 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 |
| N | N | C | N | N | QP | Q | Q | QP | Q S | Q S | Q S | Q S | Q S |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | Q | N | Q | Q | N | C | 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 | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | Q | N | N | N | N | N | N | N | N |
| N | P | P | P | P | P | N | N | P | P | P | P | P | P |
| N | P | P | P | P | P | P | P | P | P | P | P | P | P |
| N | Q | C | Q | Q | QP | Q S | Q S | QP | Q | Q | Q | Q | Q |
| N | P | C | P | P | P | C | C | C | C | C | C | C | C |
| N | N | C | N | N | C | C | C | P | Q | 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 |
| N | N | N | N | N | 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 | N | N | N | N | N | N | N | N |
| N | Q | N | N | N | Q | 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 | C | C | C | C | C | P | Q | Q | Q | Q | Q |
| Clear Spring Health Value Rx (PDP) S6946-008 | Wellcare Classic (PDP) S4802-083 | American Health Advantage of Florida (HMO I-SNP) H6652-001 | Florida Complete Care (HMO I-SNP) H9986-001 | Florida Complete Care- In The Community (HMO I-SNP) H9986-002 | Longevity Health Plan (HMO I-SNP) H1644-001 | Premier Care (HMO I-SNP) H9917-004 | Senior Care (HMO I-SNP) H9917-001 | Simply Comfort (HMO I-SNP) H5471-068 | UHC Care Advantage FL-E001 (PPO I-SNP) H0710-012 | UHC Nursing Home Plan EX-F001 (PPO I-SNP) H0710-004 | UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP) H5322-003 | UHC Nursing Home Plan FL-F001 (PPO I-SNP) H0710-010 | UHC Nursing Home Plan FL-F002 (PPO I-SNP) H0710-038 |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | Q | P | QP | QP | Q | QP | QP | N | P | P | P | 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 | N | N | N | N | N | N | N | N | N |
| N | N | C | C | C | Q | C | C | Q S | Q | Q | Q | Q | Q |
| N | Q | C | N | N | Q | N | N | Q | C | C | C | C | C |
| N | Q | C | Q | Q | Q | C | C | Q | 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 | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | Q | N | N | N | N | N | N | N | N |
| N | QP | C | QP | QP | C | C | C | Q | C | C | C | C | C |
| N | Q | C | Q | Q | Q | C | C | Q | Q | 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 |
| N | N | N | N | N | 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 | C | C | C | C | C | C | C | C | C |
| N | C | C | C | C | Q | C | C | C | C | C | C | C | 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 | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | 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 | C | C | C | C | C | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| Clear Spring Health Value Rx (PDP) S6946-008 | Wellcare Classic (PDP) S4802-083 | American Health Advantage of Florida (HMO I-SNP) H6652-001 | Florida Complete Care (HMO I-SNP) H9986-001 | Florida Complete Care- In The Community (HMO I-SNP) H9986-002 | Longevity Health Plan (HMO I-SNP) H1644-001 | Premier Care (HMO I-SNP) H9917-004 | Senior Care (HMO I-SNP) H9917-001 | Simply Comfort (HMO I-SNP) H5471-068 | UHC Care Advantage FL-E001 (PPO I-SNP) H0710-012 | UHC Nursing Home Plan EX-F001 (PPO I-SNP) H0710-004 | UHC Nursing Home Plan EX-F006 (HMO-POS I-SNP) H5322-003 | UHC Nursing Home Plan FL-F001 (PPO I-SNP) H0710-010 | UHC Nursing Home Plan FL-F002 (PPO I-SNP) H0710-038 |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | 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 | P | P | Q | QP | QP | QP | P | P | P | P | P |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | Q S | 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 | Q | C | Q | Q | Q | C | C | Q | Q | 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 |
| 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 | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N | N | N | N |