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) S5921-351 | Cigna Secure Rx (PDP) S5617-215 | Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Aetna Medicare Longevity Plan (HMO I-SNP) H3959-066 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) H4093-001 | Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 | UHC Care Advantage PA-E001 (PPO I-SNP) H0710-067 | UHC Nursing Home Plan EX-F002 (PPO I-SNP) H0710-017 |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | 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 | N | 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 | Q | N | N | Q | Q |
| N | Q | N | Q | Q | Q | Q | C | C | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N |
| P | P | N | 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 | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | 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 | P | N | N | P | P |
| QP | P | N | N | N | N | QP | N | N | QP | QP |
| Q | Q | N | Q | Q | Q | Q | Q | Q | Q | Q |
| Q | Q | N | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N |
| QP | N | N | 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 |
| AARP Medicare Rx Basic from UHC (PDP) S5921-351 | Cigna Secure Rx (PDP) S5617-215 | Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Aetna Medicare Longevity Plan (HMO I-SNP) H3959-066 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) H4093-001 | Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 | UHC Care Advantage PA-E001 (PPO I-SNP) H0710-067 | UHC Nursing Home Plan EX-F002 (PPO I-SNP) H0710-017 |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | 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 | N | QP | QP | QP | Q | P | P | Q | Q |
| N | N | N | N | N | N | 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 | QP | N | QP | QP | N | N | QP | QP |
| N | N | N | N | N | N | N | N | N | N | N |
| Q | Q | N | Q | Q | Q | Q | C | C | Q | Q |
| C | N | N | C | C | C | C | C | C | C | C |
| N | N | N | Q | N | Q | N | N | N | N | N |
| C | P | N | 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 | Q | N | Q | Q | Q | Q | C | C | 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 | QP | N | QP | 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 |
| Q | N | N | 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 | C | C | N | N |
| P | C | N | C | C | C | P | C | C | P | P |
| N | N | N | N | N | N | N | N | N | N | N |
| C | C | N | Q | C | Q | C | C | C | C | C |
| Q | Q | N | Q | Q | Q | Q | C | C | 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 |
| AARP Medicare Rx Basic from UHC (PDP) S5921-351 | Cigna Secure Rx (PDP) S5617-215 | Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Aetna Medicare Longevity Plan (HMO I-SNP) H3959-066 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) H4093-001 | Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 | UHC Care Advantage PA-E001 (PPO I-SNP) H0710-067 | UHC Nursing Home Plan EX-F002 (PPO I-SNP) H0710-017 |
| N | N | N | C | N | C | C | C | C | C | C |
| AARP Medicare Rx Basic from UHC (PDP) S5921-351 | Cigna Secure Rx (PDP) S5617-215 | Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Aetna Medicare Longevity Plan (HMO I-SNP) H3959-066 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) H4093-001 | Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 | UHC Care Advantage PA-E001 (PPO I-SNP) H0710-067 | UHC Nursing Home Plan EX-F002 (PPO I-SNP) H0710-017 |
| C | Q | N | Q | C | Q | C | C | C | C | C |
| N | N | N | N | Q | Q | Q | C | C | Q | Q |
| N | N | N | N | N | N | Q | N | N | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | Q | N | N | N | N | N | N | N |
| Q | Q | N | C | C | C | Q | C | C | Q | Q |
| N | Q | N | Q | N | Q | Q | C | C | Q | Q |
| C S | C S | N | C S | N | C S | C S | C | C | C S | C S |
| N | C | N | C | N | C | C | C | C | C | C |
| Q | Q | N | QP | QP | QP | Q | QP | QP | 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 | QP | N | N | P | N | QP | N | N | QP | QP |
| 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 |
| C | C | N | N | N | N | C | N | N | C | C |
| C | C | N | N | N | N | C | N | N | C | C |
| C | C | N | N | N | N | C | N | N | C | C |
| N | N | N | N | N | N | N | N | N | N | N |
| C | C | N | N | N | N | C | N | N | C | C |
| C | C | N | N | N | N | C | N | N | C | C |
| Q | Q | N | Q | Q | Q | Q | C | C | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | C | C | N | N |
| N | N | N | N | N | N | N | C | C | N | N |
| N | N | N | N | N | N | N | C | C | N | N |
| C | Q | N | Q | Q | Q | C | Q | Q | 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 |
| Q | Q | N | Q | Q | Q | Q | C | C | 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 | C | N | C | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| AARP Medicare Rx Basic from UHC (PDP) S5921-351 | Cigna Secure Rx (PDP) S5617-215 | Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Aetna Medicare Longevity Plan (HMO I-SNP) H3959-066 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) H4093-001 | Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 | UHC Care Advantage PA-E001 (PPO I-SNP) H0710-067 | UHC Nursing Home Plan EX-F002 (PPO I-SNP) H0710-017 |
| N | N | N | N | N | 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 | N | N | N |
| Q | QP | N | QP | Q | QP | Q | P | P | Q | Q |
| N | C | N | C | C | C | C | N | N | C | C |
| N | C | N | C | N | 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 | Q | C | C | Q | Q |
| N | C | N | C | C | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N |
| QP | P | N | P | P | P | QP | P | P | QP | QP |
| 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 | C | Q | C | C | C | C | C | C |
| QP | QP | N | QP | P | QP | QP | C | C | QP | QP |
| QP | QP | N | QP | N | QP | QP | C | C | 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 | Q | N | Q | 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 | N | N | N | N | N | N | N |
| N | N | N | Q | Q | Q | Q | C | C | 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 | C | C | C | C | C | C | C | C |
| N | N | N | N | N | C | N | C | C | N | N |
| N | N | N | N | N | C | N | C | C | N | N |
| N | N | N | C | C | C | N | C | C | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| AARP Medicare Rx Basic from UHC (PDP) S5921-351 | Cigna Secure Rx (PDP) S5617-215 | Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Aetna Medicare Longevity Plan (HMO I-SNP) H3959-066 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) H4093-001 | Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 | UHC Care Advantage PA-E001 (PPO I-SNP) H0710-067 | UHC Nursing Home Plan EX-F002 (PPO I-SNP) H0710-017 |
| Q | C | N | Q | Q | Q | Q | C | C | Q | Q |
| Q | N | N | QP | N | QP | Q | C | C | 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 |
| QP | P | N | P | C | P | QP | P | P | QP | QP |
| N | N | N | N | N | N | N | N | N | N | N |
| Q | C | N | Q | Q | Q | Q | C | C | Q | Q |
| N | N | N | QP | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| Q | Q | N | Q | Q | Q | Q | C | C | 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 | Q S | C | C | Q S | Q S |
| 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 | N | N | N | N | N | N | N | N | N |
| P | P | N | P | P | P | P | N | N | P | P |
| P | P | N | P | P | P | P | P | P | P | P |
| Q | Q | N | Q | Q | Q | Q | C | C | Q | Q |
| C | P | N | P | P | P | C | C | C | C | C |
| N | N | N | P | N | P | Q | C | C | 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 |
| Q | N | N | N | Q | 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 |
| Q | Q | N | C | C | C | Q | C | C | Q | Q |
| AARP Medicare Rx Basic from UHC (PDP) S5921-351 | Cigna Secure Rx (PDP) S5617-215 | Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Aetna Medicare Longevity Plan (HMO I-SNP) H3959-066 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) H4093-001 | Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 | UHC Care Advantage PA-E001 (PPO I-SNP) H0710-067 | UHC Nursing Home Plan EX-F002 (PPO I-SNP) H0710-017 |
| N | N | N | N | N | N | N | N | N | N | N |
| P | P | N | QP | Q | 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 | Q | N | Q | Q | C | C | Q | Q |
| C | Q | N | Q | Q | Q | C | Q | Q | C | C |
| C | Q | N | Q | Q | Q | C | Q | Q | 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 |
| C | Q | N | QP | QP | QP | C | C | C | C | C |
| Q | Q | N | Q | Q | Q | Q | C | C | 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 |
| C | P | N | C | C | C | C | N | N | C | C |
| C | C | N | 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 | N |
| N | N | N | N | N | N | N | N | N | 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 | N | C | C | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N |
| AARP Medicare Rx Basic from UHC (PDP) S5921-351 | Cigna Secure Rx (PDP) S5617-215 | Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Aetna Medicare Longevity Plan (HMO I-SNP) H3959-066 | Erickson Advantage Guardian (HMO-POS I-SNP) H5652-003 | Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) H4093-001 | Provider Partners Pennsylvania Community Plan (HMO I-SNP) H4093-004 | UHC Care Advantage PA-E001 (PPO I-SNP) H0710-067 | UHC Nursing Home Plan EX-F002 (PPO I-SNP) H0710-017 |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | 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 | QP | N | P | QP | P | P | C | C | 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 |
| Q | Q | 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 | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |