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) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Humana Together in Health (PPO I-SNP) H5216-447 | WV Senior Advantage (HMO I-SNP) H9153-001 |
| 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 |
| N | P | P | P | P |
| N | N | N | N | N |
| N | N | N | QP | N |
| N | N | Q | Q | Q |
| N | N | N | N | N |
| N | 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 | QP | N |
| N | Q | Q | Q | C |
| N | Q | Q | Q | Q S |
| N | N | N | N | N |
| N | QP | QP | 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 |
| Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Humana Together in Health (PPO I-SNP) H5216-447 | WV Senior Advantage (HMO I-SNP) H9153-001 |
| 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 | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | Q | Q | Q | C |
| N | N | C | C | N |
| N | N | N | N | N |
| N | C | C | C | C |
| N | N | N | N | N |
| 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 | QP | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | Q | Q | Q | Q |
| N | N | N | N | N |
| N | N | N | Q | N |
| N | C | C | C | C |
| N | N | N | N | N |
| N | Q | C | C | C |
| N | 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 |
| Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Humana Together in Health (PPO I-SNP) H5216-447 | WV Senior Advantage (HMO I-SNP) H9153-001 |
| N | C | N | N | C |
| Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Humana Together in Health (PPO I-SNP) H5216-447 | WV Senior Advantage (HMO I-SNP) H9153-001 |
| N | Q | C | Q | C |
| N | N | Q | Q | Q S |
| N | N | N | Q | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | C | C | Q | Q |
| N | Q | N | Q | Q |
| N | N | N | Q S | Q S |
| N | C | N | N | N |
| N | QP | QP | Q | Q |
| 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 | C | N |
| N | N | N | C | N |
| N | N | N | C | N |
| N | N | N | N | N |
| N | N | N | C | N |
| N | N | N | C | N |
| N | Q | Q | Q | Q |
| N | N | N | N | N |
| N | N | C | N | Q |
| N | N | C | N | Q |
| N | N | C | N | Q |
| N | Q | Q | Q | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | Q | Q | Q | 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) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Humana Together in Health (PPO I-SNP) H5216-447 | WV Senior Advantage (HMO I-SNP) H9153-001 |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | QP | Q | Q | C |
| N | N | N | C | Q |
| N | C | N | N | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | Q | Q |
| N | N | C | Q | Q |
| N | N | N | N | N |
| N | P | P | QP | P |
| N | N | N | N | N |
| N | N | N | N | N |
| N | C | Q | Q | C |
| N | QP | P | QP | Q |
| N | QP | N | QP | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | Q S |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | Q | Q | Q | C |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | C | C | N | N |
| N | N | N | C | N |
| N | N | N | C | N |
| N | C | N | C | N |
| N | N | N | N | N |
| Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Humana Together in Health (PPO I-SNP) H5216-447 | WV Senior Advantage (HMO I-SNP) H9153-001 |
| N | Q | Q | Q | C |
| N | QP | N | Q | Q S |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | P | C | P | P |
| N | N | N | N | N |
| N | Q | Q | Q | Q |
| N | N | N | N | N |
| N | N | N | N | N |
| N | Q | Q | Q | Q S |
| N | N | N | N | N |
| N | N | N | N | N |
| N | Q | Q | QP | 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 | P | N | N | N |
| N | P | P | P | P |
| N | Q | Q | Q | Q |
| N | P | P | 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 | C | C | Q | Q |
| Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Humana Together in Health (PPO I-SNP) H5216-447 | WV Senior Advantage (HMO I-SNP) H9153-001 |
| N | N | N | N | N |
| N | QP | Q | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | Q | N | Q | N |
| N | N | Q | Q | N |
| N | Q | Q | Q S | C |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | Q | N |
| N | QP | QP | Q | Q |
| N | 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 | C | N | C |
| N | 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 | C | Q | C | C |
| N | N | N | N | N |
| Clear Spring Health Value Rx (PDP) S6946-003 | SilverScript Choice (PDP) S5601-012 | Wellcare Classic (PDP) S4802-080 | Humana Together in Health (PPO I-SNP) H5216-447 | WV Senior Advantage (HMO I-SNP) H9153-001 |
| 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 |
| 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 |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |
| N | N | N | N | N |