Key
C | Covered - No restrictions |
Q | Has quantity limits |
S | Has step therapy |
P | Has prior authorization |
N | Not Covered |
| Cigna Healthcare Assurance Rx (PDP) S5617-148 | Clear Spring Health Value Rx (PDP) S6946-025 | Humana Basic Rx Plan (PDP) S5884-113 | Wellcare Classic (PDP) S4802-020 | AgeRight Advantage Health Plan (HMO I-SNP) H1372-001 | AgeRight Advantage Plus Health Plan (HMO I-SNP) H1372-002 | UHC Care Advantage OR-E001 (PPO I-SNP) H0710-037 | UHC Care Advantage OR-E002 (HMO-POS I-SNP) H3113-008 | UHC Nursing Home Plan OR-F001 (PPO I-SNP) H0710-036 | UHC Nursing Home Plan OR-F002 (PPO I-SNP) H2406-033 |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | 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 | 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 | N | N | Q | Q | Q | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| 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 | P | P | P |
| P | N | N | N | QP | QP | QP | QP | QP | QP |
| Q | N | Q | Q | Q | Q | Q | Q | Q | Q |
| Q | N | Q | Q | QP | QP | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | 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 |
| Cigna Healthcare Assurance Rx (PDP) S5617-148 | Clear Spring Health Value Rx (PDP) S6946-025 | Humana Basic Rx Plan (PDP) S5884-113 | Wellcare Classic (PDP) S4802-020 | AgeRight Advantage Health Plan (HMO I-SNP) H1372-001 | AgeRight Advantage Plus Health Plan (HMO I-SNP) H1372-002 | UHC Care Advantage OR-E001 (PPO I-SNP) H0710-037 | UHC Care Advantage OR-E002 (HMO-POS I-SNP) H3113-008 | UHC Nursing Home Plan OR-F001 (PPO I-SNP) H0710-036 | UHC Nursing Home Plan OR-F002 (PPO I-SNP) H2406-033 |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | 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 | QP | Q | Q | Q | Q | Q | Q |
| 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 | N | N | N |
| N | N | N | N | N | N | QP | QP | QP | QP |
| N | N | N | N | N | N | N | N | N | N |
| Q | N | Q | Q | C | C | C | C | C | C |
| N | N | C | C | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| 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 |
| Q | N | Q | Q | C | C | 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 | Q | 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 |
| C | N | C | C | P | P | P | P | P | P |
| N | N | N | N | N | N | N | N | N | N |
| C | N | C | C | C | C | C | C | C | C |
| Q | N | Q | 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 |
| Cigna Healthcare Assurance Rx (PDP) S5617-148 | Clear Spring Health Value Rx (PDP) S6946-025 | Humana Basic Rx Plan (PDP) S5884-113 | Wellcare Classic (PDP) S4802-020 | AgeRight Advantage Health Plan (HMO I-SNP) H1372-001 | AgeRight Advantage Plus Health Plan (HMO I-SNP) H1372-002 | UHC Care Advantage OR-E001 (PPO I-SNP) H0710-037 | UHC Care Advantage OR-E002 (HMO-POS I-SNP) H3113-008 | UHC Nursing Home Plan OR-F001 (PPO I-SNP) H0710-036 | UHC Nursing Home Plan OR-F002 (PPO I-SNP) H2406-033 |
| N | N | N | N | N | N | C | C | C | C |
| Cigna Healthcare Assurance Rx (PDP) S5617-148 | Clear Spring Health Value Rx (PDP) S6946-025 | Humana Basic Rx Plan (PDP) S5884-113 | Wellcare Classic (PDP) S4802-020 | AgeRight Advantage Health Plan (HMO I-SNP) H1372-001 | AgeRight Advantage Plus Health Plan (HMO I-SNP) H1372-002 | UHC Care Advantage OR-E001 (PPO I-SNP) H0710-037 | UHC Care Advantage OR-E002 (HMO-POS I-SNP) H3113-008 | UHC Nursing Home Plan OR-F001 (PPO I-SNP) H0710-036 | UHC Nursing Home Plan OR-F002 (PPO I-SNP) H2406-033 |
| Q | N | Q | C | Q | Q | C | C | C | C |
| N | N | N | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | 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 |
| Q | N | Q | C | Q | Q | Q | Q | Q | Q |
| Q | N | Q | N | N | N | C | C | C | C |
| C S | N | N | N | C S | C S | C S | C S | C S | C S |
| C | N | N | N | C | C | C | C | C | C |
| Q | N | Q | QP | 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 |
| QP | N | QP | N | N | N | 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 |
| C | N | N | N | C | C | C | C | C | C |
| C | N | N | N | C | C | C | C | C | C |
| C | N | N | N | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| C | N | N | N | C | C | C | C | C | C |
| C | N | N | N | C | C | C | C | C | C |
| Q | N | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | C | N | N | N | N | N | N |
| N | N | N | C | N | N | N | N | N | N |
| N | N | N | C | N | N | N | N | N | N |
| Q | N | Q | Q | QP | QP | 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 |
| Q | N | Q | Q | 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 |
| Cigna Healthcare Assurance Rx (PDP) S5617-148 | Clear Spring Health Value Rx (PDP) S6946-025 | Humana Basic Rx Plan (PDP) S5884-113 | Wellcare Classic (PDP) S4802-020 | AgeRight Advantage Health Plan (HMO I-SNP) H1372-001 | AgeRight Advantage Plus Health Plan (HMO I-SNP) H1372-002 | UHC Care Advantage OR-E001 (PPO I-SNP) H0710-037 | UHC Care Advantage OR-E002 (HMO-POS I-SNP) H3113-008 | UHC Nursing Home Plan OR-F001 (PPO I-SNP) H0710-036 | UHC Nursing Home Plan OR-F002 (PPO I-SNP) H2406-033 |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | 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 | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | C | N | N | N | C | C | C | C |
| C | N | N | 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 |
| Q | N | Q | N | Q | Q | Q | Q | Q | Q |
| C | N | Q | C | Q | Q | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| P | N | QP | P | Q | Q | QP | QP | QP | QP |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| C | N | Q | Q | C | C | C | C | C | C |
| QP | N | QP | P | Q | Q | QP | QP | QP | QP |
| QP | N | QP | N | N | N | 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 | Q | Q | C | C | 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 | C | C | C | C | C | C |
| N | N | C | N | N | N | N | N | N | N |
| N | N | C | 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 |
| Cigna Healthcare Assurance Rx (PDP) S5617-148 | Clear Spring Health Value Rx (PDP) S6946-025 | Humana Basic Rx Plan (PDP) S5884-113 | Wellcare Classic (PDP) S4802-020 | AgeRight Advantage Health Plan (HMO I-SNP) H1372-001 | AgeRight Advantage Plus Health Plan (HMO I-SNP) H1372-002 | UHC Care Advantage OR-E001 (PPO I-SNP) H0710-037 | UHC Care Advantage OR-E002 (HMO-POS I-SNP) H3113-008 | UHC Nursing Home Plan OR-F001 (PPO I-SNP) H0710-036 | UHC Nursing Home Plan OR-F002 (PPO I-SNP) H2406-033 |
| C | N | Q | Q | C | C | Q | Q | Q | Q |
| N | N | Q | N | C | C | 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 |
| P | N | P | C | P | P | QP | QP | QP | QP |
| N | N | N | N | N | N | N | N | N | N |
| C | N | Q | Q | Q | Q | Q | Q | Q | Q |
| N | N | N | N | Q | Q | N | N | N | N |
| N | N | N | N | N | N | N | N | N | N |
| Q | N | Q | Q | C | C | 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 | N | QP | Q | Q | Q | Q S | 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 | 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 | N | P | P | P | P | P | P | P | P |
| Q | N | Q | Q | Q S | Q S | Q | Q | Q | Q |
| P | N | C | P | C | C | C | C | C | C |
| N | N | N | N | N | N | 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 | N | N | N | N |
| Q | N | Q | C | C | C | Q | Q | Q | Q |
| Cigna Healthcare Assurance Rx (PDP) S5617-148 | Clear Spring Health Value Rx (PDP) S6946-025 | Humana Basic Rx Plan (PDP) S5884-113 | Wellcare Classic (PDP) S4802-020 | AgeRight Advantage Health Plan (HMO I-SNP) H1372-001 | AgeRight Advantage Plus Health Plan (HMO I-SNP) H1372-002 | UHC Care Advantage OR-E001 (PPO I-SNP) H0710-037 | UHC Care Advantage OR-E002 (HMO-POS I-SNP) H3113-008 | UHC Nursing Home Plan OR-F001 (PPO I-SNP) H0710-036 | UHC Nursing Home Plan OR-F002 (PPO I-SNP) H2406-033 |
| N | N | N | N | N | N | N | N | N | N |
| P | N | N | Q | QP | QP | 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 | C | C | Q | Q | Q | Q |
| Q | N | Q | Q | N | N | N | N | N | N |
| Q | N | Q S | Q | Q | Q | 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 | Q | N | N | N | N | N | N | N |
| Q | N | Q | QP | Q | Q | C | C | C | C |
| Q | N | C | Q | C | C | 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 |
| P | N | N | C | C | C | C | 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 |
| C | N | C | Q | C | C | C | C | C | C |
| N | N | N | N | N | N | N | N | N | N |
| Cigna Healthcare Assurance Rx (PDP) S5617-148 | Clear Spring Health Value Rx (PDP) S6946-025 | Humana Basic Rx Plan (PDP) S5884-113 | Wellcare Classic (PDP) S4802-020 | AgeRight Advantage Health Plan (HMO I-SNP) H1372-001 | AgeRight Advantage Plus Health Plan (HMO I-SNP) H1372-002 | UHC Care Advantage OR-E001 (PPO I-SNP) H0710-037 | UHC Care Advantage OR-E002 (HMO-POS I-SNP) H3113-008 | UHC Nursing Home Plan OR-F001 (PPO I-SNP) H0710-036 | UHC Nursing Home Plan OR-F002 (PPO I-SNP) H2406-033 |
| N | N | N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | 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 | QP | P | P | P | P |
| 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 |
| Q | N | C | Q | C | C | 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 |