HealthSpring Extra Rx (PDP)
Contract S5617, plan 385, segment 0 · offered by MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY · CMS PDP Region 38 (Puerto Rico).
Plan features
| Monthly premium | $50.00 |
|---|---|
| Annual deductible | $615.00Tier 1 and 2 exempt |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,348 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Puerto Rico | at least 1,58654 counties suppressed by CMS (under 11 enrollees) |
| Members nationally | 1,830 |
| Member services | (800)222-6700TTY 711 |
| Pharmacy search | www.cigna.com/part-d |
| BIN / PCN | 017010 / CIMCARESee BIN/PCNs for all plans |
CMS star ratings
- Part D summary rating
- 2.5 out of 5 stars for Part D summary rating
Published per contract, which is how CMS scores them — every plan under contract S5617 shares this rating.
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $0.00 | 313 |
| Tier 2 | $5.00 | 377 |
| Tier 3 | 17% | 978 |
| Tier 4 | 31% | 933 |
| Tier 5 | 25% | 747 |
Cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $6.00 | $0.00 | $0.00 | $18.00 | $0.00 |
| Tier 2: Generic | $5.00 | $12.00 | $5.00 | $15.00 | $36.00 | $3.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $6.00 | $0.00 | $0.00 | $18.00 | $0.00 |
| Tier 2: Generic | $5.00 | $12.00 | $5.00 | $15.00 | $36.00 | $3.00 |
| Tier 3: Preferred Brand | 17% | 21% | 17% | 17% | 21% | 17% |
| Tier 4: Non-Preferred Drug | 31% | 33% | 31% | 31% | 33% | 31% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | 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% | 0% | 0% | 0% | 0% | 0% |
| 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.