MedicarePartD.guide

A non-government resource built from CMS public data

HealthSpring Extra Rx (PDP)

Contract S5617, plan 362, segment 0 · offered by MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY · CMS PDP Region 12 (Tennessee).

Plan features

Monthly premium$77.50
Annual deductible$615.00Tier 1 and 2 exempt
Drug benefit type—
$0 premium with full LIS—
Premium with Extra Help (LIS)—
Formulary drugs3,348
Formulary exception tier—
Mail order offered—
Plan reach—
Members in Tennessee—
Members nationally—
Member services—
BIN / PCN—

CMS star ratings

Summary rating
2.5 out of 5 stars for Summary rating
Customer service
—
Member experience
—
Drug pricing & patient safety
—

Formulary tiers — preferred pharmacy, initial coverage phase

TierCost-sharingDrugs on tier
Tier 1$0.00—
Tier 2$5.00—
Tier 317%—
Tier 431%—
Tier 525%—

Cost-sharing by coverage phase

Tier30-day supply90-day supply
PreferredStandardMail OrderPreferredStandardMail 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 Brand17%19%17%17%19%17%
Tier 4: Non-Preferred Drug31%33%31%31%33%31%
Tier 5: Specialty Tier25%25%25%n/an/an/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 Drug0%0%0%0%0%0%
Tier 5: Specialty Tier$0.00$0.00$0.00$0.00$0.00$0.00