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Medicare Prescription Drug Plan Cost-Sharing Details
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
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2015 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Cigna-HealthSpring Rx Secure-Max (PDP) (S5617-242-0)
Benefit Details        
This plan is available in CMS PDP Region 31
which includes: ID UT

Monthly Premium: $127.10
Rx Deductible: $0
Initial Coverage Limit: $2,960 Qualifies for LIS: No

Click on a letter below to view the
Cigna-HealthSpring Rx Secure-Max (PDP) 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*
This plan does not have an Initial Deductible:n/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $1.00 $4.00 $1.00 $3.00 $12.00 $3.00
Tier 2: Non-Preferred Generic: $2.00 $8.00 $2.00 $6.00 $24.00 $6.00
Tier 3: Preferred Brand: $30.00 $40.00 $30.00 $90.00 $120.00 $90.00
Tier 4: Non-Preferred Brand: $85.00 $95.00 $85.00 $255.00 $285.00 $255.00
Tier 5: Specialty Tier: 33% 33% 33% 33% 33% 33%
Coverage Gap (Donut Hole) Phase Cost Sharing
35% Generic and 55% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap
Tier 1: Preferred Generic: $1.00(A) $4.00(A) $1.00(A) $3.00(A) $12.00(A) $3.00(A)
Tier 2: Non-Preferred Generic: $2.00(A) $8.00(A) $2.00(A) $6.00(A) $24.00(A) $6.00(A)
Tier 3: Preferred Brand: $30.00(P) $40.00(P) $30.00(P) $90.00(P) $120.00(P) $90.00(P)
Tier 4: Non-Preferred Brand: $85.00(P) $95.00(P) $85.00(P) $255.00(P) $285.00(P) $255.00(P)
All Formulary Generic Drugs: 65% 65% 65% 65% 65% 65%
All Formulary Brand-Name Drugs: 45% 45% 45% 45% 45% 45%
Catastrophic Coverage Phase Cost Sharing
Generic & Preferred Multi-Source Drugs: The greater of 5% or $2.65 The greater of 5% or $2.65
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $6.60 The greater of 5% or $6.60
Notes:
*The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.
(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 Rx Secure-Max (PDP) 2015 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 
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