Key
C | Covered - No restrictions |
Q | Has quantity limits |
S | Has step therapy |
P | Has prior authorization |
N | Not Covered |
| AARP Medicare Rx Saver from UHC (PDP) S5921-361 | Cigna Healthcare Assurance Rx (PDP) S5617-223 | Clear Spring Health Value Rx (PDP) S6946-013 | Humana Basic Rx Plan (PDP) S5884-139 | SilverScript Choice (PDP) S5601-032 | Wellcare Classic (PDP) S4802-097 | UHC Care Advantage WI-E001 (HMO-POS I-SNP) H5253-064 | UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP) H5253-007 |
| N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N |
| 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 |
| 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 | N |
| P | P | 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 | N | N | N | N |
| P | N | N | N | N | N | P | P |
| QP | P | N | N | N | N | QP | QP |
| Q | Q | N | Q | Q | Q | Q | Q |
| Q | Q | N | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | 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 |
| AARP Medicare Rx Saver from UHC (PDP) S5921-361 | Cigna Healthcare Assurance Rx (PDP) S5617-223 | Clear Spring Health Value Rx (PDP) S6946-013 | Humana Basic Rx Plan (PDP) S5884-139 | SilverScript Choice (PDP) S5601-032 | Wellcare Classic (PDP) S4802-097 | UHC Care Advantage WI-E001 (HMO-POS I-SNP) H5253-064 | UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP) H5253-007 |
| N | N | N | N | N | N | N | N |
| N | 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 | 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 | QP | QP |
| N | N | N | N | N | N | N | N |
| C | Q | N | Q | Q | Q | C | C |
| C | N | N | C | C | C | C | C |
| N | N | N | N | Q | N | N | N |
| C | P | N | C | C | C | C | C |
| N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N |
| N | Q | N | 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 |
| Q | N | N | N | Q | Q | N | N |
| N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N |
| P | C | N | C | C | C | P | P |
| N | N | N | N | N | N | N | N |
| C | C | N | C | Q | C | C | C |
| Q | Q | N | Q | Q | 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 |
| AARP Medicare Rx Saver from UHC (PDP) S5921-361 | Cigna Healthcare Assurance Rx (PDP) S5617-223 | Clear Spring Health Value Rx (PDP) S6946-013 | Humana Basic Rx Plan (PDP) S5884-139 | SilverScript Choice (PDP) S5601-032 | Wellcare Classic (PDP) S4802-097 | UHC Care Advantage WI-E001 (HMO-POS I-SNP) H5253-064 | UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP) H5253-007 |
| N | N | N | N | C | N | C | C |
| AARP Medicare Rx Saver from UHC (PDP) S5921-361 | Cigna Healthcare Assurance Rx (PDP) S5617-223 | Clear Spring Health Value Rx (PDP) S6946-013 | Humana Basic Rx Plan (PDP) S5884-139 | SilverScript Choice (PDP) S5601-032 | Wellcare Classic (PDP) S4802-097 | UHC Care Advantage WI-E001 (HMO-POS I-SNP) H5253-064 | UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP) H5253-007 |
| C | Q | N | Q | Q | C | C | C |
| N | N | N | N | 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 |
| Q | Q | N | Q | C | C | Q | Q |
| N | Q | N | Q | Q | N | C | C |
| C S | C S | N | N | C S | N | C S | C S |
| N | C | N | N | C | N | C | C |
| Q | Q | N | 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 | QP | N | QP | N | N | QP | QP |
| 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 |
| C | C | N | N | N | N | C | C |
| C | C | N | N | N | N | C | C |
| C | C | N | N | N | N | C | C |
| N | N | N | N | N | N | N | N |
| C | C | N | N | N | N | C | C |
| C | C | N | N | N | N | C | C |
| Q | Q | N | 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 | C | N | N |
| N | N | N | N | N | C | N | N |
| C | Q | N | 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 |
| C | Q | N | 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 | N | N | N | N | N | N | N |
| AARP Medicare Rx Saver from UHC (PDP) S5921-361 | Cigna Healthcare Assurance Rx (PDP) S5617-223 | Clear Spring Health Value Rx (PDP) S6946-013 | Humana Basic Rx Plan (PDP) S5884-139 | SilverScript Choice (PDP) S5601-032 | Wellcare Classic (PDP) S4802-097 | UHC Care Advantage WI-E001 (HMO-POS I-SNP) H5253-064 | UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP) H5253-007 |
| N | N | N | N | N | N | N | N |
| 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 | Q | QP | Q | Q | Q |
| N | N | N | C | C | N | C | C |
| N | C | N | N | C | N | C | C |
| N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N |
| Q | Q | N | Q | N | N | Q | Q |
| N | C | N | Q | C | C | C | C |
| N | N | N | N | N | N | N | N |
| QP | P | N | QP | P | P | QP | QP |
| N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N |
| C | C | N | Q | C | Q | C | C |
| QP | QP | N | QP | QP | P | QP | QP |
| QP | QP | N | QP | QP | N | 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 | 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 |
| C | N | N | N | C | C | C | C |
| N | N | N | C | N | N | N | N |
| N | N | N | C | N | N | N | N |
| N | N | N | C | C | N | N | N |
| N | N | N | N | N | N | N | N |
| AARP Medicare Rx Saver from UHC (PDP) S5921-361 | Cigna Healthcare Assurance Rx (PDP) S5617-223 | Clear Spring Health Value Rx (PDP) S6946-013 | Humana Basic Rx Plan (PDP) S5884-139 | SilverScript Choice (PDP) S5601-032 | Wellcare Classic (PDP) S4802-097 | UHC Care Advantage WI-E001 (HMO-POS I-SNP) H5253-064 | UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP) H5253-007 |
| Q | C | N | Q | Q | Q | Q | Q |
| Q | N | N | Q | QP | 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 | N | N |
| QP | P | N | P | P | C | QP | QP |
| N | N | N | N | N | N | N | N |
| Q | C | N | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N |
| Q | Q | N | Q | Q | Q | Q | Q |
| N | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N |
| Q S | QP | N | QP | Q | Q | 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 |
| P | N | N | N | P | N | P | P |
| P | P | N | P | P | P | P | P |
| Q | Q | N | Q | Q | Q | Q | Q |
| C | P | N | C | P | P | C | C |
| N | N | N | N | P | 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 | N | N |
| Q | N | N | N | N | N | N | N |
| Q | N | N | N | N | N | N | N |
| N | N | N | N | N | N | N | N |
| Q | Q | N | Q | C | C | Q | Q |
| AARP Medicare Rx Saver from UHC (PDP) S5921-361 | Cigna Healthcare Assurance Rx (PDP) S5617-223 | Clear Spring Health Value Rx (PDP) S6946-013 | Humana Basic Rx Plan (PDP) S5884-139 | SilverScript Choice (PDP) S5601-032 | Wellcare Classic (PDP) S4802-097 | UHC Care Advantage WI-E001 (HMO-POS I-SNP) H5253-064 | UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP) H5253-007 |
| N | N | N | N | N | N | N | N |
| P | P | N | N | QP | Q | 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 | Q | N | Q | Q |
| N | Q | N | Q | N | Q | N | N |
| C | Q | N | Q S | 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 | Q | N | N | N | N |
| C | Q | N | Q | QP | QP | C | C |
| Q | Q | N | 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 |
| C | P | N | N | C | C | C | 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 | N | N |
| 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 | Q | C | C |
| N | N | N | N | N | N | N | N |
| AARP Medicare Rx Saver from UHC (PDP) S5921-361 | Cigna Healthcare Assurance Rx (PDP) S5617-223 | Clear Spring Health Value Rx (PDP) S6946-013 | Humana Basic Rx Plan (PDP) S5884-139 | SilverScript Choice (PDP) S5601-032 | Wellcare Classic (PDP) S4802-097 | UHC Care Advantage WI-E001 (HMO-POS I-SNP) H5253-064 | UHC Nursing Home Plan WI-F001 (HMO-POS I-SNP) H5253-007 |
| N | N | N | N | N | N | N | N |
| 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 | QP | P | QP | 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 |
| Q | Q | N | 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 |