This is archive material for research purposes. Please see
PDPFinder.com or
MAFinder.com for current plans.
2018 Medicare Advantage Plan Prescription Drug Cost-Sharing Details
| 2018 Medicare Advantage Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
|
Cigna-HealthSpring Preferred KNX (HMO) (H4454-031-0) Benefit Details 
 | ||||||
| This plan is available in Morgan County, TN Monthly Premium: $8.00 Rx Deductible: $150 Initial Coverage Limit: $3,750 Click on a letter below to view the Cigna-HealthSpring Preferred KNX (HMO) Formulary A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 | ||||||
| This Plan Uses Lower Cost-Sharing for Preferred Pharmacies | ||||||
| 30-Day Supply Cost-Sharing |
90-Day Supply Cost-Sharing |
|||||
| Preferred Pharmacy | Standard Pharmacy | Mail- Order* | Preferred Pharmacy | Standard Pharmacy | Mail- Order* | |
| Initial Deductible Phase Cost Sharing | ||||||
| Tier 1: Preferred Generic: | $3.00(E) | $8.00(E) | n/a(E) | $6.00(E) | $16.00(E) | n/a(E) |
| Tier 2: Generic: | $12.00(E) | $17.00(E) | n/a(E) | $24.00(E) | $34.00(E) | n/a(E) |
| Tier 3: Preferred Brand: | 100% | 100% | 100% | 100% | 100% | 100% |
| Tier 4: Non-Preferred Drug: | 100% | 100% | 100% | 100% | 100% | 100% |
| Tier 5: Specialty Tier: | 100% | 100% | 100% | 100% | 100% | 100% |
| Initial Coverage Phase Cost-Sharing | ||||||
| Tier 1: Preferred Generic: | $3.00 | $8.00 | n/a | $6.00 | $16.00 | n/a |
| Tier 2: Generic: | $12.00 | $17.00 | n/a | $24.00 | $34.00 | n/a |
| Tier 3: Preferred Brand: | $42.00 | $47.00 | n/a | $126.00 | $141.00 | n/a |
| Tier 4: Non-Preferred Drug: | $95.00 | $100.00 | n/a | $285.00 | $300.00 | n/a |
| Tier 5: Specialty Tier: | 30% | 30% | n/a | n/a | n/a | n/a |
| Coverage Gap (Donut Hole) Phase Cost Sharing 56% Generic and 65% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap | ||||||
| Tier 1: Preferred Generic: | $3.00(A) | $8.00(A) | n/a | $6.00(A) | $16.00(A) | n/a |
| All Formulary Generic Drugs: | 44% | 44% | 44% | 44% | 44% | 44% |
| All Formulary Brand-Name Drugs: | 35% | 35% | 35% | 35% | 35% | 35% |
| Catastrophic Coverage Phase Cost Sharing | ||||||
| Generic & Preferred Multi-Source Drugs: | The greater of 5% or $3.35 | The greater of 5% or $3.35 | ||||
| Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): | The greater of 5% or $8.35 | The greater of 5% or $8.35 | ||||
| Notes: *The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing. (E) Drugs on this tier are excluded from the Initial Deductible and do not count toward meeting the deductible. (A) Coverage Gap cost-sharing applies to all drugs on the designated tier. Drugs that are covered in the coverage gap also receive the donut hole discount. (P) Coverage Gap cost-sharing applies to only some of drugs on the designated drug tier. Drugs that are covered in the coverage gap also receive the donut hole discount. | ||||||
| Go to the Cigna-HealthSpring Preferred KNX (HMO) 2018 Formulary Browser by choosing a letter below: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 0-9 | ||||||