State PDP Region Organizatio Plan Name Drug Plan Drug No Offers Type of
n Name Premium 1 Deductible Premium Variable Extra
with Full Copayment Coverage
Low s Offered in
Income (Tiers) the Gap
Subsidy (G=generics;
Aetna
Medicare
Aetna Rx
Texas 22 Medicare Essentials $30.70 $250
Aetna
Aetna Medicare
Texas 22 Medicare Rx Plus $40.95 $0 G
Aetna
Medicare
Aetna Rx
Texas 22 Medicare Premier $56.39 $0 G
CIGNATU
CIGNA RE Rx
HealthCar Value
Texas 22 e Plan $34.20 $250
CIGNA CIGNATU
HealthCar RE Rx
Texas 22 e Plus Plan $39.54 $0
CIGNATU
CIGNA RE Rx
HealthCar Complete
Texas 22 e Plan $47.88 $0 G
Coventry
AdvantraR AdvantraR
Texas 22 x x Value $23.24 $0
Coventry
AdvantraR AdvantraR
Texas 22 x x Premier $33.72 $0
Coventry AdvantraR
AdvantraR x Premier
Texas 22 x Plus $45.04 $0
Elder Elder
Health Health
PDP PDP
Texas 22 Texas Texas $29.75 $250
HISC -
Blue
Cross Blue
Blue Medicare
Shield of Rx -
Texas 22 Texas Standard $25.53 $250
HISC -
Blue
Cross
Blue Blue
Shield of Medicare
Texas 22 Texas Rx - Value $25.73 $0
HISC -
Blue
Cross
Blue Blue
Shield of Medicare
Texas 22 Texas Rx - Plus $43.32 $0
Humana
PDP
Standard
Humana S5884-
Texas 22 Inc. 080 $10.31 $250
Humana
PDP
Enhanced
Humana S5884-
Texas 22 Inc. 020 $14.13 $0
Humana
PDP
Complete
Humana S5884-
Texas 22 Inc. 050 $58.69 $0 G/B
Prescripti
Marquette on
National Pathway
Life Silver
Insurance Plan Reg
Texas 22 Company 22 $40.66 $250
Marquette Prescripti
National on
Life Pathway
Insurance Gold Plan
Texas 22 Company Reg 22 $51.83 $0
Prescripti
Marquette on
National Pathway
Life Platinum
Insurance Plan Reg
Texas 22 Company 22 $68.41 $0
Medco
Health
Solutions, YOURx
Texas 22 Inc. PLAN $32.82 $250
Communit
MEMBER y Care Rx
Texas 22 HEALTH BASIC $30.79 $250
Communit
MEMBER y Care Rx
Texas 22 HEALTH CHOICE $38.87 $250
Communit
MEMBER y Care Rx
Texas 22 HEALTH GOLD $42.77 $100
PacifiCare
Life and
Health PacifiCare
Insurance Saver
Texas 22 Company Plan $27.94 $0
PacifiCare
Life and
Health PacifiCare
Insurance Select
Texas 22 Company Plan $42.24 $0
PacifiCare
Life and
Health PacifiCare
Insurance Comprehe
Texas 22 Company nsive Plan $46.83 $0 G
Prescripti
on
Pennsylva Pathway
nia Life Bronze
Insurance Plan Reg
Texas 22 Company 22 $31.25 $250
Prescripti
on
Pennsylva Pathway
nia Life Silver
Insurance Plan
Texas 22 Company Reg22 $40.58 $250
Prescripti
Pennsylva on
nia Life Pathway
Insurance Gold Plan
Texas 22 Company Reg 22 $51.77 $0
Advantag
RxAmeric e Star
Texas 22 a Plan $30.82 $250
Advantag
e
RxAmeric Freedom
Texas 22 a Plan $33.49 $250
Texas 22 SierraRx SierraRx $28.14 $250
SilverScri
SilverScri
Texas 22 pt pt $30.77 $250
SilverScri
SilverScri
Texas 22 pt pt Plus $59.51 $100
Sterling Sterling
Prescripti
Prescripti
on Drug on Drug
Texas 22 Plan Plan $54.21 $100
Texas Texas
HealthSpri
HealthSpri
ng ng
Prescripti
Prescripti
on Drug on Drug
Texas 22 Plan Plan $24.78 $250
Scott &
White
Health
Plan
Texas Rx Texas RX
Texas 22 Plan Basic $39.61 $0
Scott &
White
Health
PlanTexa
Texas Rx s RX
Texas 22 Plan Enhanced $52.05 $0
Medicare
Rx
Texas 22 Unicare Rewards $23.93 $250
Medicare
Rx
Rewards
Texas 22 Unicare Plus $31.91 $0
Medicare
Rx
Rewards
Texas 22 Unicare Premier $42.57 $0 G
UA
Medicare
United Part D
American Prescripti
Insurance on Drug
Texas 22 Company Cov $36.69 $0
United AARP
Healthcar Medicare
Texas 22 e Rx Plan $28.25 $0
United
United Medicare
Healthcar MedAdva
Texas 22 e nce $31.45 $0
WellCare
Texas 22 WellCare Signature $23.66 $0
WellCare
Texas 22 WellCare Complete $44.91 $0
WellCare
Texas 22 WellCare Premier $48.28 $0
Sources: CMS PDP Landscape of Local Plans Source File
Number of Number of Number of Mail Order contract # plan # segement # formulary benefit_type
Top 100 Top 100 Top 100 Offered
Drugs on Drugs Drugs with
Formulary 2 Requiring Cost
Prior Sharing
Authorizati below $20 2
86 5 54 S5810 056 0 2662 Actuarially Equivalent Standard
86 5 54 S5810 158 0 2662 Enhanced Alternative
100 38 78 S5810 192 0 2681 Enhanced Alternative
99 31 86 S5617 108 0 1241 Actuarially Equivalent Standard
99 31 57 S5617 110 0 1241 Enhanced Alternative
99 31 57 S5617 192 0 1241 Enhanced Alternative
78 9 57 S5670 117 0 2764 Enhanced Alternative
100 12 57 S5670 118 0 2759 Enhanced Alternative
100 12 N/A S5670 120 0 2766 Basic Alternative
91 8 58 S1566 001 0 Actuarially Equivalent Standard
100 13 N/A S5715 009 0 627 Defined Standard Benefit
100 13 57 S5715 005 0 627 Basic Alternative
100 13 92 S5715 006 0 627 Enhanced Alternative
99 8 N/A S5884 080 0 1863 Defined Standard Benefit
99 8 56 S5884 020 0 1863 Enhanced Alternative
99 8 56 S5884 050 0 1863 Enhanced Alternative
92 1 57 S5581 133 0 1446 Actuarially Equivalent Standard
92 1 57 S5581 037 0 1446 Enhanced Alternative
100 0 57 S5581 061 0 1494 Enhanced Alternative
98 10 95 S5660 022 0 3164 Basic Alternative
95 10 58 S5803 091 0 3422 Actuarially Equivalent Standard
95 10 91 S5803 159 0 3422 Actuarially Equivalent Standard
95 10 58 S5803 125 0 3422 Enhanced Alternative
78 9 53 S5921 192 0 2654 Basic Alternative
87 3 54 S5921 191 0 2656 Basic Alternative
78 9 53 S5921 193 0 2654 Enhanced Alternative
92 1 N/A S5597 087 0 1446 Defined Standard Benefit
92 1 57 S5597 186 0 1446 Actuarially Equivalent Standard
92 1 57 S5597 054 0 1446 Enhanced Alternative
88 12 N/A S5644 079 0 1479 Actuarially Equivalent Standard
100 12 N/A S5644 058 0 1644 Defined Standard Benefit
78 9 55 S5917 001 0 2021 Basic Alternative
92 5 92 S5601 044 0 897 Actuarially Equivalent Standard
98 5 56 S5601 045 0 619 Basic Alternative
98 5 56 S4802 013 0 3245 Basic Alternative
89 22 N/A S5740 001 0 3107 Defined Standard Benefit
95 4 56 S5915 001 0 32 Basic Alternative
95 4 56 S5915 002 0 32 Enhanced Alternative
92 5 56 S5960 022 0 2493 Actuarially Equivalent Standard
92 5 56 S5960 058 0 2493 Enhanced Alternative
98 5 57 S5960 092 0 2546 Enhanced Alternative
99 10 58 S5755 025 0 3296 Basic Alternative
100 2 58 S5820 021 0 3440 Basic Alternative
100 2 58 S5820 125 0 3440 Basic Alternative
88 12 56 S5967 056 0 2249 Basic Alternative
85 9 74 S5967 090 0 2003 Enhanced Alternative
85 9 56 S5967 125 0 2629 Enhanced Alternative
icl_amount STCD
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
0 TX
2250 TX
2000 TX
2000 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2000 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
2250 TX
1850 TX
2250 TX