| Plan |
Prior
Authorization
|
Quantity
Limits
|
Step
Therapy
|
|
Plans that cover all 10 drugs
|
| AARP |
0 |
10 |
1 |
| Aetna Premier |
1 |
6 |
1 |
| BlueScript Option 1 |
0 |
0 |
0 |
| BlueScript Option 2 |
0 |
0 |
0 |
| CCRX BASIC |
0 |
1 |
2 |
| CCRX CHOICE |
0 |
1 |
2 |
| CRX GOLD |
0 |
1 |
2 |
| Humana Complete |
0 |
3 |
0 |
| Humana Enhanced |
0 |
3 |
0 |
| Humana Standard |
0 |
3 |
0 |
| Medicare RX Rewards Premier |
0 |
6 |
0 |
| SilverScript |
2 |
3 |
0 |
| SilverScript Plus |
2 |
3 |
0 |
| Sterling |
2 |
3 |
0 |
| United MedAdvance |
0 |
10 |
1 |
|
Plans that cover nine of 10 drugs
|
| AdvantraRx Premier |
2 |
8 |
1 |
| AdvantraRx Premier Plus |
2 |
8 |
1 |
| AHC |
0 |
7 |
2 |
| CIGNATURE Complete |
0 |
0 |
5 |
| CIGNATURE Plus |
0 |
0 |
5 |
| CIGNATURE Value |
0 |
0 |
5 |
| Prescription Pathway Platinum |
0 |
3 |
0 |
| UA |
2 |
9 |
0 |
| YOURx PLAN |
2 |
9 |
0 |
|
Plans that cover eight of 10 drugs
|
| Aetna Essentials |
0 |
4 |
0 |
| Aetna Plus |
0 |
4 |
0 |
| Medicare RX Rewards |
0 |
4 |
0 |
| Medicare RX Rewards Plus |
0 |
4 |
0 |
| Prescription Pathway Bronze |
0 |
3 |
0 |
| Prescription Pathway Gold |
0 |
3 |
0 |
| Prescription Pathway Silver |
0 |
3 |
0 |
| WellCare Signature |
0 |
0 |
1 |
| Plans that cover seven of 10 drugs |
| PacifiCare Select |
0 |
0 |
1 |
| WellCare Complete |
0 |
0 |
0 |
| WellCare Premier |
0 |
0 |
0 |
|
Plans that cover six of 10 drugs
|
| Masterpiece |
0 |
4 |
2 |
| Masterpiece Choice |
0 |
4 |
2 |
| PacifiCare Comprehensive |
2 |
0 |
1 |
| PacifiCare Saver |
2 |
0 |
1 |
| Plans that cover four of 10 drugs |
| AdvantraRx Value |
1 |
3 |
0 |
| Plans that cover three of 10 drugs |
| AmeriHealth Advantage |
|
|
|
