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
Tennesse Aetna Rx
e 12 Medicare Essentials $38.86 $250
Aetna
Tennesse Aetna Medicare
e 12 Medicare Rx Plus $50.45 $0 G
Aetna
Medicare
Tennesse Aetna Rx
e 12 Medicare Premier $66.75 $0 G
AmeriHeal
AmeriHeal th
th Advantag
Tennesse Advantag e Rx
e 12 e Option l $25.68 $250
CIGNATU
CIGNA RE Rx
Tennesse HealthCar Value
e 12 e Plan $37.27 $250
CIGNA CIGNATU
Tennesse HealthCar RE Rx
e 12 e Plus Plan $42.38 $0
CIGNATU
CIGNA RE Rx
Tennesse HealthCar Complete
e 12 e Plan $51.03 $0 G
Coventry
Tennesse AdvantraR AdvantraR
e 12 x x Value $22.86 $0
Coventry
Tennesse AdvantraR AdvantraR
e 12 x x Premier $33.99 $0
Coventry AdvantraR
Tennesse AdvantraR x Premier
e 12 x Plus $43.85 $0
First First
Tennesse Health Health
e 12 Premier Premier $21.80 $250
HealthSpri HealthSpri
ng ng
Prescripti Prescripti
Tennesse on Drug on Drug
e 12 Plan Plan $25.54 $250
Humana
PDP
Standard
Tennesse Humana S5884-
e 12 Inc. 070 $14.08 $250
Humana
PDP
Enhanced
Tennesse Humana S5884-
e 12 Inc. 001 $22.48 $0
Humana
PDP
Complete
Tennesse Humana S5884-
e 12 Inc. 040 $67.16 $0 G/B
Prescripti
Marquette on
National Pathway
Life Silver
Tennesse Insurance Plan Reg
e 12 Company 12 $42.41 $250
Marquette Prescripti
National on
Life Pathway
Tennesse Insurance Gold Plan
e 12 Company Reg 12 $53.31 $0
Prescripti
Marquette on
National Pathway
Life Platinum
Tennesse Insurance Plan Reg
e 12 Company 12 $69.98 $0
Medco
Health
Tennesse Solutions, YOURx
e 12 Inc. PLAN $30.11 $250
Communit
Tennesse MEMBER y Care Rx
e 12 HEALTH BASIC $33.31 $250
Communit
Tennesse MEMBER y Care Rx
e 12 HEALTH CHOICE $41.41 $250
Communit
Tennesse MEMBER y Care Rx
e 12 HEALTH GOLD $45.23 $100
PacifiCare
Life and
Health PacifiCare
Tennesse Insurance Saver
e 12 Company Plan $34.88 $0
PacifiCare
Life and
Health PacifiCare
Tennesse Insurance Select
e 12 Company Plan $47.47 $0
PacifiCare
Life and
Health PacifiCare
Tennesse Insurance Comprehe
e 12 Company nsive Plan $53.70 $0 G
Prescripti
on
Pennsylva Pathway
nia Life Bronze
Tennesse Insurance Plan Reg
e 12 Company 12 $33.07 $250
Prescripti
on
Pennsylva Pathway
nia Life Silver
Tennesse Insurance Plan
e 12 Company Reg12 $42.32 $250
Prescripti
Pennsylva on
nia Life Pathway
Tennesse Insurance Gold Plan
e 12 Company Reg 12 $53.25 $0
Advantag
e
Tennesse RxAmeric Allegiance
e 12 a Plan $34.92 $250
Advantag
e
Tennesse RxAmeric Freedom
e 12 a Plan $36.04 $250
Tennesse SilverScri SilverScri
e 12 pt pt $32.34 $250
Tennesse SilverScri SilverScri
e 12 pt pt Plus $61.25 $100
Medicare
Tennesse Rx
e 12 Unicare Rewards $29.65 $250
Medicare
Rx
Tennesse Rewards
e 12 Unicare Plus $37.34 $0
Medicare
Rx
Tennesse Rewards
e 12 Unicare Premier $49.77 $0 G
UA
Medicare
United Part D
American Prescripti
Tennesse Insurance on Drug
e 12 Company Cov $36.88 $0
United AARP
Tennesse Healthcar Medicare
e 12 e Rx Plan $27.28 $0
United
United Medicare
Tennesse Healthcar MedAdva
e 12 e nce $31.54 $0
Tennesse WellCare
e 12 WellCare Signature $26.46 $0
Tennesse WellCare
e 12 WellCare Complete $45.10 $0
Tennesse WellCare
e 12 WellCare Premier $48.95 $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 046 0 2662 Actuarially Equivalent Standard
86 5 54 S5810 148 0 2662 Enhanced Alternative
100 38 78 S5810 182 0 2681 Enhanced Alternative
92 13 N/A S5783 005 0 3416 Defined Standard Benefit
99 31 86 S5617 058 0 1241 Actuarially Equivalent Standard
99 31 57 S5617 060 0 1241 Enhanced Alternative
99 31 57 S5617 182 0 1241 Enhanced Alternative
78 9 57 S5670 063 0 2764 Enhanced Alternative
100 12 77 S5670 064 0 2759 Enhanced Alternative
100 12 22 S5670 066 0 2766 Basic Alternative
100 12 N/A S5768 015 0 1727 Defined Standard Benefit
89 22 N/A S5932 001 0 3122 Defined Standard Benefit
99 8 N/A S5884 070 0 1863 Defined Standard Benefit
99 8 56 S5884 001 0 1863 Enhanced Alternative
99 8 56 S5884 040 0 1863 Enhanced Alternative
92 1 57 S5581 125 0 1446 Actuarially Equivalent Standard
92 1 57 S5581 029 0 1446 Enhanced Alternative
100 0 57 S5581 053 0 1494 Enhanced Alternative
98 10 95 S5660 012 0 3164 Basic Alternative
95 10 58 S5803 081 0 3422 Actuarially Equivalent Standard
95 10 91 S5803 149 0 3422 Actuarially Equivalent Standard
95 10 58 S5803 115 0 3422 Enhanced Alternative
78 9 53 S5921 152 0 2654 Basic Alternative
87 3 54 S5921 151 0 2656 Basic Alternative
78 9 53 S5921 153 0 2654 Enhanced Alternative
92 1 N/A S5597 077 0 1446 Defined Standard Benefit
92 1 57 S5597 176 0 1446 Actuarially Equivalent Standard
92 1 57 S5597 044 0 1446 Enhanced Alternative
88 12 N/A S5644 012 0 1479 Defined Standard Benefit
100 12 N/A S5644 056 0 1644 Defined Standard Benefit
92 5 92 S5601 024 0 897 Actuarially Equivalent Standard
98 5 56 S5601 025 0 619 Basic Alternative
92 5 56 S5960 012 0 2493 Actuarially Equivalent Standard
92 5 56 S5960 048 0 2493 Enhanced Alternative
98 5 57 S5960 082 0 2546 Enhanced Alternative
99 10 58 S5755 015 0 3296 Basic Alternative
100 2 58 S5820 011 0 3440 Basic Alternative
100 2 58 S5820 115 0 3440 Basic Alternative
88 12 56 S5967 046 0 2366 Basic Alternative
85 9 74 S5967 080 0 2003 Enhanced Alternative
85 9 56 S5967 115 0 2629 Enhanced Alternative
icl_amount STCD
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
0 TN
2250 TN
2000 TN
2000 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2000 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
2250 TN
1850 TN
2250 TN