Key
C | Covered - No restrictions |
Q | Has quantity limits |
S | Has step therapy |
P | Has prior authorization |
N | Not Covered |
| AARP Medicare Rx Basic from UHC (PDP) S5921-348 | Clear Spring Health Value Rx (PDP) S6946-060 | Wellcare Classic (PDP) S4802-076 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Longevity Health Plan (HMO I-SNP) H9940-001 |
| N | 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 | P | P | P |
| N | N | N | N | N |
| N | N | N | Q | Q |
| N | N | Q | Q | Q |
| N | N | N | N | N |
| P | N | 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 | N | N |
| N | N | N | N | N |
| P | N | N | P | P |
| QP | N | N | QP | QP |
| Q | N | Q | Q | Q |
| Q | N | Q | Q | Q |
| N | N | N | N | N |
| QP | N | 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 |
| AARP Medicare Rx Basic from UHC (PDP) S5921-348 | Clear Spring Health Value Rx (PDP) S6946-060 | Wellcare Classic (PDP) S4802-076 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Longevity Health Plan (HMO I-SNP) H9940-001 |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | QP | Q | QP |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | QP | QP |
| N | N | N | N | C |
| Q | N | Q | Q | C |
| C | N | C | C | C |
| N | N | N | N | N |
| C | N | C | C | C |
| N | N | N | N | N |
| N | N | N | N | 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 |
| Q | N | Q | N | C |
| N | N | N | N | N |
| N | N | N | N | N |
| P | N | C | P | C |
| N | N | N | N | N |
| C | N | C | C | C |
| Q | 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 |
| AARP Medicare Rx Basic from UHC (PDP) S5921-348 | Clear Spring Health Value Rx (PDP) S6946-060 | Wellcare Classic (PDP) S4802-076 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Longevity Health Plan (HMO I-SNP) H9940-001 |
| N | N | N | C | C |
| AARP Medicare Rx Basic from UHC (PDP) S5921-348 | Clear Spring Health Value Rx (PDP) S6946-060 | Wellcare Classic (PDP) S4802-076 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Longevity Health Plan (HMO I-SNP) H9940-001 |
| C | N | C | C | Q |
| N | N | Q | Q | Q |
| N | N | N | Q | N |
| N | N | N | N | N |
| N | N | N | N | N |
| Q | N | C | Q | C |
| N | N | N | Q | Q |
| C S | N | N | C S | C |
| N | N | N | C | C |
| Q | N | QP | Q | QP |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | P | QP | QP |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | C |
| N | N | N | N | C |
| C | N | N | C | C |
| C | N | N | C | C S |
| C | N | N | C | C |
| N | N | N | N | N |
| C | N | N | C | C |
| C | N | N | C | C |
| Q | N | Q | Q | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| C | N | Q | C | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| Q | N | Q | Q | C |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | Q |
| N | N | N | N | N |
| AARP Medicare Rx Basic from UHC (PDP) S5921-348 | Clear Spring Health Value Rx (PDP) S6946-060 | Wellcare Classic (PDP) S4802-076 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Longevity Health Plan (HMO I-SNP) H9940-001 |
| N | N | N | C | C S |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| Q | N | Q | Q | C |
| N | N | C | C | C |
| N | N | N | C | C |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | Q | Q |
| N | N | C | C | C |
| N | N | N | N | N |
| QP | N | P | QP | P |
| N | N | N | N | N |
| N | N | N | N | N |
| C | N | Q | C | Q |
| QP | N | P | QP | P |
| QP | 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 | Q | Q | C |
| N | N | N | N | P |
| N | N | N | N | N |
| N | N | N | N | N |
| C | N | C | C | C |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | C | N | N |
| N | N | N | N | N |
| AARP Medicare Rx Basic from UHC (PDP) S5921-348 | Clear Spring Health Value Rx (PDP) S6946-060 | Wellcare Classic (PDP) S4802-076 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Longevity Health Plan (HMO I-SNP) H9940-001 |
| Q | N | Q | Q | C |
| Q | N | N | Q | C |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| QP | N | C | QP | P |
| N | N | N | N | N |
| Q | N | Q | Q | C |
| N | N | N | N | N |
| N | N | N | N | N |
| Q | N | Q | Q | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | Q S | QP |
| N | N | N | N | N |
| N | N | Q | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | Q |
| P | N | P | P | P |
| P | N | P | P | P |
| Q | N | Q | Q | QP |
| C | N | P | C | P |
| N | N | N | Q | C |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| Q | N | Q | N | Q |
| Q | N | Q | N | Q |
| N | N | N | N | N |
| Q | N | C | Q | C |
| AARP Medicare Rx Basic from UHC (PDP) S5921-348 | Clear Spring Health Value Rx (PDP) S6946-060 | Wellcare Classic (PDP) S4802-076 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Longevity Health Plan (HMO I-SNP) H9940-001 |
| N | N | N | N | N |
| P | N | Q | P | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | Q | Q |
| C | N | Q | C | Q |
| C | N | Q | C | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | Q |
| C | N | QP | C | C |
| Q | N | Q | Q | Q |
| 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 | N | C | C | Q |
| 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 |
| C | N | C | C | C |
| N | N | N | N | N |
| AARP Medicare Rx Basic from UHC (PDP) S5921-348 | Clear Spring Health Value Rx (PDP) S6946-060 | Wellcare Classic (PDP) S4802-076 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Longevity Health Plan (HMO I-SNP) H9940-001 |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| P | N | QP | P | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| Q | N | Q | Q | Q |
| 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 |