HealthSpring Assurance Rx (PDP)
Contract S5617, plan 223, segment 0 · offered by MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY · CMS PDP Region 16 (Wisconsin).
Plan features
| Monthly premium | $0.00 |
|---|---|
| Annual deductible | $615.00 |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,265 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Wisconsin | 24,118 |
| Members nationally | 24,486 |
| 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 | 5% | 216 |
| Tier 2 | 10% | 484 |
| Tier 3 | 25% | 631 |
| Tier 4 | 30% | 1,172 |
| Tier 5 | 25% | 762 |
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 | 5% | 10% | 5% | 5% | 10% | 5% |
| Tier 2: Generic | 10% | 14% | 10% | 10% | 14% | 10% |
| Tier 3: Preferred Brand | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 30% | 31% | 30% | 30% | 31% | 30% |
| 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.