Humana Basic Rx Plan (PDP)
Contract S5884, plan 115, segment 0 · offered by Humana Insurance Co. & Humana Insurance Co. of NY · CMS PDP Region 33 (Hawaii).
Plan features
| Monthly premium | $0.40 |
|---|---|
| Annual deductible | $615.00 |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,042 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Hawaii | 2,019 |
| Members nationally | 2,070 |
| Member services | (800)281-6918TTY 711 |
| Pharmacy search | www.humana.com/pharmacy/ |
| BIN / PCN | 015581 / 03200000See BIN/PCNs for all plans |
CMS star ratings
- Part D summary rating
- 3 out of 5 stars for Part D summary rating
Published per contract, which is how CMS scores them — every plan under contract S5884 shares this rating.
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $3.00 | 176 |
| Tier 2 | $4.00 | 533 |
| Tier 3 | 23% | 778 |
| Tier 4 | 28% | 930 |
| Tier 5 | 25% | 625 |
Cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $3.00 | $3.00 | $0.00 | $9.00 | $9.00 | $0.00 |
| Tier 2: Generic | $4.00 | $4.00 | $0.00 | $12.00 | $12.00 | $0.00 |
| Tier 3: Preferred Brand | 23% | 23% | 18% | 23% | 23% | 18% |
| Tier 4: Non-Preferred Drug | 28% | 28% | 28% | n/a | n/a | n/a |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 2: Generic | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 3: Preferred Brand | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 4: Non-Preferred Drug | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 5: Specialty Tier | 0% | 0% | 0% | 0% | 0% | 0% |
Plan facts come from the CMS quarterly prescription drug plan public use files.