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) S6946-015 | SilverScript Choice (PDP) S5601-036 | Wellcare Classic (PDP) S4802-072 | American Health Advantage of Missouri (HMO I-SNP) H4490-001 | American Health Advantage of Missouri Choice (HMO I-SNP) H4490-003 | NHC Advantage (HMO I-SNP) H4172-001 | Provider Partners Missouri Advantage Plan (HMO I-SNP) H9191-001 | Provider Partners Missouri Community Plan (HMO I-SNP) H9191-004 | Provider Partners Missouri Essential Plan (HMO I-SNP) H9191-005 | Senior Care (HMO I-SNP) H4172-003 | UHC Nursing Home Plan MO-F001 (PPO I-SNP) H0710-016 |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | 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 |
| 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 | Q | Q | Q | Q | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | 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 | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | 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 | QP | QP | QP | N | N | N | QP | QP |
| N | Q | Q | C | C | Q | C | C | C | Q | Q |
| N | Q | Q | Q S | Q S | QP | Q S | Q S | Q S | QP | Q |
| N | N | N | N | N | N | N | N | N | N | N |
| N | 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 |
| Clear Spring Health Value Rx (PDP) S6946-015 | SilverScript Choice (PDP) S5601-036 | Wellcare Classic (PDP) S4802-072 | American Health Advantage of Missouri (HMO I-SNP) H4490-001 | American Health Advantage of Missouri Choice (HMO I-SNP) H4490-003 | NHC Advantage (HMO I-SNP) H4172-001 | Provider Partners Missouri Advantage Plan (HMO I-SNP) H9191-001 | Provider Partners Missouri Community Plan (HMO I-SNP) H9191-004 | Provider Partners Missouri Essential Plan (HMO I-SNP) H9191-005 | Senior Care (HMO I-SNP) H4172-003 | UHC Nursing Home Plan MO-F001 (PPO I-SNP) H0710-016 |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | 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 | QP | Q | QP | QP | QP | Q | Q |
| N | N | N | 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 | QP |
| N | N | N | N | N | N | N | N | N | N | N |
| N | Q | Q | C | C | C | C | C | C | C | C |
| N | N | C | C | C | C | N | N | N | C | C |
| N | N | N | N | N | N | N | N | N | N | N |
| N | 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 | Q | Q | Q | Q | C | Q | Q | Q | 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 | N | N | N | N | N | 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 | Q | Q | Q | Q | Q | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | C | N | N | N | C | N |
| N | C | C | C | C | P | C | C | C | P | P |
| N | N | N | N | N | N | N | N | N | N | N |
| N | Q | C | C | C | C | C | C | C | C | C |
| N | 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 |
| Clear Spring Health Value Rx (PDP) S6946-015 | SilverScript Choice (PDP) S5601-036 | Wellcare Classic (PDP) S4802-072 | American Health Advantage of Missouri (HMO I-SNP) H4490-001 | American Health Advantage of Missouri Choice (HMO I-SNP) H4490-003 | NHC Advantage (HMO I-SNP) H4172-001 | Provider Partners Missouri Advantage Plan (HMO I-SNP) H9191-001 | Provider Partners Missouri Community Plan (HMO I-SNP) H9191-004 | Provider Partners Missouri Essential Plan (HMO I-SNP) H9191-005 | Senior Care (HMO I-SNP) H4172-003 | UHC Nursing Home Plan MO-F001 (PPO I-SNP) H0710-016 |
| N | C | N | C | C | N | C | C | C | N | C |
| Clear Spring Health Value Rx (PDP) S6946-015 | SilverScript Choice (PDP) S5601-036 | Wellcare Classic (PDP) S4802-072 | American Health Advantage of Missouri (HMO I-SNP) H4490-001 | American Health Advantage of Missouri Choice (HMO I-SNP) H4490-003 | NHC Advantage (HMO I-SNP) H4172-001 | Provider Partners Missouri Advantage Plan (HMO I-SNP) H9191-001 | Provider Partners Missouri Community Plan (HMO I-SNP) H9191-004 | Provider Partners Missouri Essential Plan (HMO I-SNP) H9191-005 | Senior Care (HMO I-SNP) H4172-003 | UHC Nursing Home Plan MO-F001 (PPO I-SNP) H0710-016 |
| N | Q | C | C | C | Q | C | C | C | Q | C |
| N | N | Q | Q S | Q S | Q | Q S | Q S | Q S | Q | Q |
| N | N | 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 | C | C | Q | Q | Q | Q | Q | Q | Q | Q |
| N | Q | N | Q | Q | N | Q | Q | Q | N | C |
| N | N | N | Q S | Q S | C S | Q S | Q S | Q S | C S | C S |
| N | C | N | N | N | C | N | N | N | C | C |
| N | QP | QP | 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 | 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 | C | N | N | N | C | C |
| N | N | N | N | N | C | N | N | N | C | C |
| N | N | N | N | N | C | N | N | N | C | C |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | C | N | N | N | C | C |
| N | N | N | N | N | C | N | N | N | C | C |
| N | Q | Q | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | C | Q | Q | N | Q | Q | Q | N | N |
| N | N | C | Q | Q | N | Q | Q | Q | N | N |
| N | N | C | Q | Q | N | Q | Q | Q | N | N |
| N | Q | Q | Q | Q | QP | Q | Q | Q | QP | 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 | Q | Q | 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 |
| Clear Spring Health Value Rx (PDP) S6946-015 | SilverScript Choice (PDP) S5601-036 | Wellcare Classic (PDP) S4802-072 | American Health Advantage of Missouri (HMO I-SNP) H4490-001 | American Health Advantage of Missouri Choice (HMO I-SNP) H4490-003 | NHC Advantage (HMO I-SNP) H4172-001 | Provider Partners Missouri Advantage Plan (HMO I-SNP) H9191-001 | Provider Partners Missouri Community Plan (HMO I-SNP) H9191-004 | Provider Partners Missouri Essential Plan (HMO I-SNP) H9191-005 | Senior Care (HMO I-SNP) H4172-003 | UHC Nursing Home Plan MO-F001 (PPO I-SNP) H0710-016 |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | 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 | Q | C | C | Q | C | C | C | Q | Q |
| N | N | N | Q | Q | N | Q | Q | Q | N | C |
| N | C | N | Q | Q | C | Q | 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 | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | C | Q | Q | Q | Q | Q | Q | Q | C |
| N | N | N | N | N | N | N | N | N | N | N |
| N | P | P | P | P | Q | P | P | P | Q | QP |
| 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 | C | C | C | C | C | C | C | C |
| N | QP | P | Q | Q | Q | Q | Q | Q | Q | QP |
| N | QP | N | 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 | Q S | Q S | N | Q S | 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 |
| N | Q | Q | C | C | C | C | 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 | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | C | C | N | N | C | 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 | C | 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) S6946-015 | SilverScript Choice (PDP) S5601-036 | Wellcare Classic (PDP) S4802-072 | American Health Advantage of Missouri (HMO I-SNP) H4490-001 | American Health Advantage of Missouri Choice (HMO I-SNP) H4490-003 | NHC Advantage (HMO I-SNP) H4172-001 | Provider Partners Missouri Advantage Plan (HMO I-SNP) H9191-001 | Provider Partners Missouri Community Plan (HMO I-SNP) H9191-004 | Provider Partners Missouri Essential Plan (HMO I-SNP) H9191-005 | Senior Care (HMO I-SNP) H4172-003 | UHC Nursing Home Plan MO-F001 (PPO I-SNP) H0710-016 |
| N | Q | Q | C | C | C | C | C | C | C | Q |
| N | QP | N | Q S | Q S | C | Q S | Q S | Q S | 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 | N | N | N | N | N | N |
| N | P | C | C | C | P | P | P | P | P | QP |
| N | N | N | N | N | N | N | N | N | N | N |
| N | Q | Q | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | Q | N | N | N | Q | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | Q | Q | Q S | Q S | C | Q S | Q S | Q S | 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 | Q | Q | Q | Q | Q | Q | Q | Q | Q | 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 | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | P | N | QP | QP | N | N | N | N | N | P |
| N | P | P | P | P | P | P | P | P | P | P |
| N | Q | Q | Q | Q | Q S | Q | Q | Q | Q S | Q |
| N | P | P | C | C | C | C | C | C | C | C |
| N | N | N | C | C | 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 | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | 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 | Q | Q | C | Q | Q | Q | C | Q |
| Clear Spring Health Value Rx (PDP) S6946-015 | SilverScript Choice (PDP) S5601-036 | Wellcare Classic (PDP) S4802-072 | American Health Advantage of Missouri (HMO I-SNP) H4490-001 | American Health Advantage of Missouri Choice (HMO I-SNP) H4490-003 | NHC Advantage (HMO I-SNP) H4172-001 | Provider Partners Missouri Advantage Plan (HMO I-SNP) H9191-001 | Provider Partners Missouri Community Plan (HMO I-SNP) H9191-004 | Provider Partners Missouri Essential Plan (HMO I-SNP) H9191-005 | Senior Care (HMO I-SNP) H4172-003 | UHC Nursing Home Plan MO-F001 (PPO I-SNP) H0710-016 |
| N | N | N | N | N | N | N | N | N | N | N |
| N | QP | Q | N | N | QP | N | 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 | N |
| N | Q | N | N | N | C | N | N | N | C | Q |
| N | N | Q | N | N | N | N | N | N | N | N |
| N | Q | Q | C | C | Q | C | C | C | 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 | N | N | N | N | N | N | N | N |
| N | QP | QP | Q | Q | Q | Q | Q | Q | Q | C |
| N | Q | Q | Q | Q | C | Q | Q | Q | 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 | N | N | N | N | N | N |
| N | N | C | C | C | C | C | C | C | C | C |
| N | 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 | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | 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 | C | C | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N | N |
| Clear Spring Health Value Rx (PDP) S6946-015 | SilverScript Choice (PDP) S5601-036 | Wellcare Classic (PDP) S4802-072 | American Health Advantage of Missouri (HMO I-SNP) H4490-001 | American Health Advantage of Missouri Choice (HMO I-SNP) H4490-003 | NHC Advantage (HMO I-SNP) H4172-001 | Provider Partners Missouri Advantage Plan (HMO I-SNP) H9191-001 | Provider Partners Missouri Community Plan (HMO I-SNP) H9191-004 | Provider Partners Missouri Essential Plan (HMO I-SNP) H9191-005 | Senior Care (HMO I-SNP) H4172-003 | UHC Nursing Home Plan MO-F001 (PPO I-SNP) H0710-016 |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | 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 | QP | QP | QP | QP | QP | QP | QP | P |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | Q S | N | N | N | 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 | Q | Q | C | C | C | C | 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 | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N | N |