Butalbital / acetaminophen / caffeine (Fioricet, Esgic, and others) — plans on this site that list it on Tier 4

AMH Health

5 plans on this site

• Anthem I MaineHealth Advantage Choice (HMO-POS) — Offered in ME: Cumberland, York
• Anthem I MaineHealth Advantage Dual Plus (HMO D-SNP) — Offered in ME: 14 counties
• Anthem I MaineHealth Advantage Plus (HMO) — Offered in ME: Androscoggin, Franklin, Kennebec, Knox, Lincoln, Oxford, Penobscot, Sagadahoc, Somerset, Waldo
• Anthem | MaineHealth Chronic Care (HMO-POS C-SNP) — Offered in ME: Cumberland, York
• Anthem | MaineHealth Dual Advantage (HMO D-SNP) — Offered in ME: 14 counties

Anthem Blue Cross

2 plans on this site

• Anthem Full Dual Advantage Aligned (HMO D-SNP) — Offered in CA: Fresno, Kern, Kings, Madera, Sacramento, San Francisco, Santa Clara, Tulare
• Anthem Select (HMO-POS) — Offered in CA: Los Angeles, Orange

Anthem Blue Cross Partnership Plan

1 plan on this site

• Anthem Prime (HMO-POS) — Offered in CA: Kern, Marin, San Mateo, Stanislaus

Anthem Blue Cross and Blue Shield

24 plans on this site

• Anthem Chronic Care Advantage (HMO C-SNP) — Offered in KY: 120 counties
• Anthem Chronic Care Advantage (PPO C-SNP) — Offered in CA: Butte, Napa, Shasta, Solano, Sonoma, Sutter, Tehama, Yuba
• Anthem Dual Advantage (HMO D-SNP) — Offered in GA: 150 counties
• Anthem Dual Advantage Plus (PPO D-SNP) — Offered in VA: 127 counties
• Anthem Extra Help (HMO-POS) — Offered in OH: 88 counties
• Anthem Full Dual Advantage (HMO D-SNP) — Offered in GA: 150 counties
• Anthem Full Dual Advantage (PPO D-SNP) — Offered in CT: Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland, Windham
• Anthem Full Dual Advantage Select (HMO D-SNP) — Offered in CT: Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland, Windham
• Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) — Offered in OH: 88 counties
• Anthem I MyCare Ohio Full Dual Support (HMO D-SNP) — Offered in OH: 88 counties
• Anthem I PathWays Dual Care Advantage (HMO D-SNP) — Offered in IN: 92 counties
• Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) — Offered in IN: 92 counties
• Anthem Kidney Care (HMO-POS C-SNP) — Offered in GA: 145 counties
• Anthem Kidney Care (PPO C-SNP) — Offered in CA: 12 counties
• Anthem Medicare Advantage (HMO) — Offered in CT: Hartford, Litchfield, Middlesex, New London, Tolland, Windham
• Anthem Medicare Advantage (HMO-POS) — Offered in KY: 97 counties
• Anthem Medicare Advantage (PPO) — Offered in KY: 120 counties
• Anthem Medicare Advantage (Regional PPO) — Offered in IN: 92 counties; KY: 120 counties
• Anthem Medicare Advantage 2 (HMO-POS) — Offered in KY: 97 counties
• Anthem Medicare Advantage 2 (PPO) — Offered in IN: 72 counties
• Anthem Medicare Advantage 3 (PPO) — Offered in KY: 120 counties
• Anthem Medicare Advantage 4 (PPO) — Offered in OH: 17 counties
• Anthem Medicare Advantage 6 (HMO-POS) — Offered in IN: 42 counties
• Anthem Medicare Advantage 7 (HMO-POS) — Offered in IN: 42 counties

Anthem Blue Cross and Blue Shield HP

2 plans on this site

• Anthem HealthPlus Full Dual Advantage (HMO D-SNP) — Offered in NY: 11 counties
• Anthem HealthPlus Full Dual Advantage LTSS 2 (HMO D-SNP) — Offered in NY: Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk, Westchester

Anthem HealthKeepers

4 plans on this site

• Anthem Dual Advantage Plus (HMO D-SNP) — Offered in VA: 133 counties
• Anthem Full Dual Advantage 2 (HMO D-SNP) — Offered in MO: 85 counties
• Anthem Full Dual Advantage Support (HMO D-SNP) — Offered in VA: 133 counties
• Anthem Medicare Advantage 4 (HMO-POS) — Offered in IN: 38 counties

CDPHP Medicare Advantage

3 plans on this site

• CDPHP $0 Medicare Rx (HMO) — Offered in NY: Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington
• CDPHP Choice Rx (HMO) — Offered in NY: Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington
• CDPHP Clear Rx (HMO) — Offered in NY: Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington

CareOregon Advantage

1 plan on this site

• CareOregon Advantage Plus (HMO D-SNP) — Offered in OR: Clackamas, Columbia, Jackson, Multnomah, Washington

Excellus Health Plan Community Care LLC

4 plans on this site

• Medicare Blue Dual (HMO D-SNP) — Offered in NY: 11 counties
• Medicare Blue Dual Secure (HMO D-SNP) — Offered in NY: 11 counties
• Univera Medicare Dual (HMO D-SNP) — Offered in NY: Erie, Orleans
• Univera Medicare Total Care (HMO D-SNP) — Offered in NY: Erie, Orleans

Excellus Health Plan, Inc

14 plans on this site

• Medicare Blue Choice 024 (HMO) — Offered in NY: Cayuga, Oneida, Onondaga, Oswego
• Medicare Blue Choice 025 (HMO-POS) — Offered in NY: Cayuga, Oneida, Onondaga, Oswego
• Medicare Blue Choice 026 (HMO-POS) — Offered in NY: Cayuga, Oneida, Onondaga, Oswego
• Medicare Blue Choice 028 (HMO) — Offered in NY: 13 counties
• Medicare Blue Choice 029 (HMO-POS) — Offered in NY: 13 counties
• Medicare Blue Choice 030 (HMO-POS) — Offered in NY: 13 counties
• Medicare Blue Choice 032 (HMO-POS) — Offered in NY: Clinton, Delaware, Essex, Franklin, Fulton, Hamilton, Montgomery, Otsego
• Medicare Blue Choice Core (HMO) — Offered in NY: Livingston, Monroe, Ontario, Seneca, Wayne, Yates
• Medicare Blue Choice Optimum (HMO-POS) — Offered in NY: Livingston, Monroe, Ontario, Seneca, Wayne, Yates
• Medicare Blue Choice Prime (HMO-POS) — Offered in NY: Livingston, Monroe, Ontario, Seneca, Wayne, Yates
• Univera SeniorChoice Advanced (HMO-POS) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
• Univera SeniorChoice Basic (HMO) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
• Univera SeniorChoice Secure (HMO-POS) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
• Univera SeniorChoice Value Plus (HMO-POS) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming

Geisinger Gold

9 plans on this site

• Geisinger Gold Classic 360 Rx (HMO) — Offered in PA: 19 counties
• Geisinger Gold Classic Advantage Rx (HMO) — Offered in PA: 21 counties
• Geisinger Gold Classic Complete Rx (HMO) — Offered in PA: 37 counties
• Geisinger Gold Classic Essential Rx (HMO) — Offered in PA: 44 counties
• Geisinger Gold Preferred Advantage Rx (PPO) — Offered in PA: 29 counties
• Geisinger Gold Preferred Balance Rx (PPO) — Offered in PA: 44 counties
• Geisinger Gold Preferred Complete Rx (PPO) — Offered in PA: 44 counties
• Geisinger Gold Secure Rx (HMO D-SNP) — Offered in PA: 63 counties
• Geisinger Gold Value Rx (HMO) — Offered in PA: 63 counties

Healthy Blue

3 plans on this site

• Healthy Blue Dual Advantage (HMO D-SNP) — Offered in LA: 64 counties
• Healthy Blue Enhanced Care (HMO D-SNP) — Offered in LA: 64 counties
• Healthy Blue Full Dual Advantage (HMO D-SNP) — Offered in KS: 84 counties

Highmark Blue Cross Blue Shield

1 plan on this site

• Complete Blue PPO Signature (PPO) — Offered in WV: 20 counties

Highmark Blue Cross Blue Shield or Highmark Blue Shield

5 plans on this site

• Community Blue Medicare HMO Signature (HMO) — Offered in PA: Adams, Bradford, Carbon, Centre, Clinton, Juniata, Montour, Northampton, Wayne
• Freedom Blue PPO Classic (PPO) — Offered in PA: 17 counties
• Freedom Blue PPO Deluxe (PPO) — Offered in PA: 34 counties
• Security Blue HMO-POS Deluxe (HMO-POS) — Offered in PA: 17 counties
• Security Blue HMO-POS Standard (HMO-POS) — Offered in PA: 17 counties

Independent Health

6 plans on this site

• Independent Health's Assure Advantage (HMO C-SNP) — Offered in NY: Erie
• Independent Health's Encompass 65 RED 042 (HMO) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
• Independent Health's Encompass 65 RED 044 (HMO) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
• Independent Health's Encompass 65 RED 045 (HMO) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
• Independent Health's Medicare Family Choice (HMO I-SNP) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
• Independent Health's Medicare Passport Connect (PPO) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming

Presbyterian Health Plan

1 plan on this site

• Presbyterian Dual Plus (HMO D-SNP) — Offered in NM: 20 counties

SummaCare Medicare Advantage Plans

5 plans on this site

• SummaCare Medicare Emerald (HMO-POS) — Offered in OH: 15 counties
• SummaCare Medicare Quartz (HMO) — Offered in OH: 25 counties
• SummaCare Medicare Ruby (HMO) — Offered in OH: 25 counties
• SummaCare Medicare Sapphire (HMO-POS) — Offered in OH: 31 counties
• SummaCare Medicare Topaz (HMO) — Offered in OH: 25 counties

UPMC for Life

11 plans on this site

• UPMC for Life Essential Rx (PPO) — Offered in PA: 34 counties
• UPMC for Life HMO Deductible Rx (HMO) — Offered in OH: Harrison, Jefferson; PA: 17 counties
• UPMC for Life HMO Premier Rx (HMO) — Offered in PA: 18 counties
• UPMC for Life HMO Rx (HMO) — Offered in OH: Harrison, Jefferson; PA: 31 counties
• UPMC for Life HMO Rx Choice (HMO) — Offered in PA: 18 counties
• UPMC for Life HMO Rx Enhanced (HMO) — Offered in OH: Harrison, Jefferson; PA: 39 counties
• UPMC for Life PPO High Deductible Rx (PPO) — Offered in PA: 17 counties
• UPMC for Life PPO Premier Rx (PPO) — Offered in PA: 13 counties
• UPMC for Life PPO Rx Choice (PPO) — Offered in PA: Armstrong, Beaver, Fayette, Greene, Lawrence, Washington
• UPMC for Life PPO Rx Enhanced (PPO) — Offered in PA: 18 counties
• UPMC for Life Preferred Rx (HMO) — Offered in PA: Butler, Clarion, Westmoreland

UPMC for Life Complete Care

1 plan on this site

• UPMC for Life Complete Care (HMO D-SNP) — Offered in PA: 26 counties

VillageCareMAX

2 plans on this site

• VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) — Offered in NY: Bronx, Kings, New York, Putnam, Queens, Richmond, Westchester
• VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) — Offered in NY: Bronx, Kings, Nassau, New York, Putnam, Queens, Richmond, Westchester

Wellpoint

19 plans on this site

• Wellpoint Chronic Care Advantage (HMO C-SNP) — Offered in TX: El Paso, Hidalgo
• Wellpoint Chronic Care Advantage Select (HMO C-SNP) — Offered in TX: Bexar, Dallas, Harris
• Wellpoint Dual Advantage (HMO D-SNP) — Offered in TX: 99 counties
• Wellpoint Dual Advantage Plus (HMO D-SNP) — Offered in TX: 99 counties
• Wellpoint Dual Advantage Plus Select (HMO D-SNP) — Offered in TX: Dallas, Fort Bend, Harris, Tarrant
• Wellpoint Dual Advantage Select (HMO D-SNP) — Offered in TX: Bexar, Dallas, Fort Bend, Harris, Tarrant
• Wellpoint Extra Help (HMO) — Offered in NJ: Bergen, Camden, Essex, Hudson, Middlesex, Morris, Passaic, Union
• Wellpoint Extra Help (HMO-POS) — Offered in TN: 95 counties
• Wellpoint Full Dual Advantage (HMO D-SNP) — Offered in TX: 63 counties
• Wellpoint Full Dual Advantage (HMO-POS D-SNP) — Offered in IA: 99 counties
• Wellpoint Full Dual Advantage 2 (HMO D-SNP) — Offered in TN: 95 counties
• Wellpoint Full Dual Advantage Aligned (HMO D-SNP) — Offered in TX: 99 counties
• Wellpoint Full Dual Advantage Select (HMO D-SNP) — Offered in TX: Fort Bend, Tarrant
• Wellpoint Full Dual Advantage Support (HMO D-SNP) — Offered in TN: 95 counties
• Wellpoint Kidney Care (HMO-POS C-SNP) — Offered in TX: 56 counties
• Wellpoint Medicare Advantage (HMO-POS) — Offered in TN: 95 counties
• Wellpoint Medicare Advantage 2 (HMO-POS) — Offered in TX: 83 counties
• Wellpoint Medicare Advantage Select (HMO-POS) — Offered in TX: Dallas, Tarrant
• Wellpoint Medicare Advantage Select 1 (HMO-POS) — Offered in TX: Fort Bend, Harris, Montgomery