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2023 Medicare Prescription Drug Plan Benefit Details for the Cigna Saver Rx (PDP)
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2023 Medicare Prescription Drug Plan Details
Medicare Plan Name:Cigna Saver Rx (PDP)
   by Cigna
State:Utah
Plan ID:S5617 - 381 - 0     Click to see other plans
Member Services:1-800-222-6700 TTY users 711
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the Cigna Saver Rx (PDP) benefit details
— Medicare Plan Features —
Monthly Premium:$12.30 (see Plan Premium Details below)
Annual Deductible:$505 (Tier 1 and 2 excluded from the Deductible.)
$0 Premium if LIS Benefits?No, this plan does NOT qualify for the $0 Premium. (See premiums for partial LIS subsidy below.)
Annual Initial Coverage Limit (ICL):$4,660
Drug Benefit Type ❔Enhanced Alternative (EA)
Additional Gap Coverage?No additional gap coverage, only the Donut Hole Discount
Total Number of Formulary Drugs:3,350 drugsBrowse the Cigna Saver Rx (PDP) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. 
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$0.00$10.00$40.0050%25%
• Number of Drugs per
  Tier:		23236811891022539
Plan Offers Mail Order?Yes
Medicare Plan Pharmacy Numbers: BIN: 017010   PCN: CIMCARE   See BIN/PCNs for all plans
Plan Type (Reach):National Plan
Number of Members enrolled in this plan in Utah:1,680 members
Number of Members enrolled in this plan in your CMS Region:4,786 members     (CMS Region 31)
Number of Members enrolled in this plan nationally:324,603 members
Plan’s Summary Star Rating: 3 out of 5 Stars.
• Customer Service Rating: 4 out of 5 Stars.
• Member Experience Rating: 4 out of 5 Stars.
• Drug Cost Accuracy Rating: 3 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows: ❔
Total
Premium		Part D Basic
Premium		Part D Supplemental
Premium
$12.30$-12.60$24.90
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔100%
Subsidy		75%
Subsidy		50%
Subsidy		25%
Subsidy
Monthly Part D Premium with LIS:$12.30$12.30$12.30$12.30




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