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2015 Medicare Prescription Drug Plan Cost-Sharing Details
| 2015 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
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Cigna-HealthSpring Rx Secure-Max (PDP) (S5617-243-0) Benefit Details 
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| This plan is available in CMS PDP Region 32 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 |
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| Preferred Pharmacy | Standard Pharmacy | Mail- Order* | Preferred Pharmacy | Standard Pharmacy | Mail- Order* | |
| This plan does not have an Initial Deductible: | n/a | n/a | n/a | n/a | n/a | n/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 | ||||||