Humana Premier Rx Plan (PDP)
Contract S5884, plan 171, segment 0 · offered by Humana Insurance Co. & Humana Insurance Co. of NY · CMS PDP Region 25 (North Dakota).
Plan features
| Monthly premium | $103.70 |
|---|---|
| Annual deductible | $0.00 |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,146 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in North Dakota | at least 2,7525 counties suppressed by CMS (under 11 enrollees) |
| Members nationally | 43,055 |
| 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 | $0.00 | 386 |
| Tier 2 | $4.00 | 567 |
| Tier 3 | $45.00 | 621 |
| Tier 4 | 50% | 947 |
| Tier 5 | 33% | 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 | $0.00 | $5.00 | $0.00 | $0.00 | $15.00 | $0.00 |
| Tier 2: Generic | $4.00 | $10.00 | $0.00 | $12.00 | $30.00 | $0.00 |
| Tier 3: Preferred Brand | $45.00 | $47.00 | $45.00 | $135.00 | $141.00 | $125.00 |
| Tier 4: Non-Preferred Drug | 50% | 50% | 50% | 50% | 50% | 50% |
| Tier 5: Specialty Tier | 33% | 33% | 33% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Plan facts come from the CMS quarterly prescription drug plan public use files.