2019 Medicare Part D Plan Formulary Information |
Cigna-HealthSpring Rx Secure (PDP) (S5617-220-0)
Benefit Details
 |
The Cigna-HealthSpring Rx Secure (PDP) (S5617-220-0) Formulary Drugs Starting with the Letter I in CMS PDP Region 12 which includes: AL TN Plan Monthly Premium: $53.50 Deductible: $415 Qualifies for LIS: No |
Drugs Starting with Letter I
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
IBANDRONATE SODIUM 150 MG TABLET [Boniva] ![Compare how all Medicare Part D PDP plans in AL cover IBANDRONATE SODIUM 150 MG TABLET [Boniva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:1 /28Days |
IBRANCE 100 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
IBRANCE 125 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
IBRANCE 75 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:21 /28Days |
Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE  |
2 |
Generic |
$3.00 | $9.00 | None |
IBUPROFEN 400 MG TABLET  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
IBUPROFEN 600 MG ORAL TABLET  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
IBUPROFEN 600mg/1 500 TABLET BOTTLE  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
IBUPROFEN 800 MG ORAL TABLET  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
IBUPROFEN 800 MG TABLET  |
1 |
Preferred Generic |
$1.00 | $3.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ICLUSIG 15 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
ICLUSIG 45 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
IDHIFA 100 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
IDHIFA 50 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
ILEVRO 0.3% OPHTH DROPS  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
IMATINIB MESYLATE 100 MG TAB [Gleevec] ![Compare how all Medicare Part D PDP plans in AL cover IMATINIB MESYLATE 100 MG TAB [Gleevec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
IMATINIB MESYLATE 400 MG TAB [Gleevec] ![Compare how all Medicare Part D PDP plans in AL cover IMATINIB MESYLATE 400 MG TAB [Gleevec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
IMBRUVICA 140 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
IMBRUVICA 140 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
IMBRUVICA 280 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
IMBRUVICA 420 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMBRUVICA 560 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
IMBRUVICA 70 MG CAPSULE  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
IMIPRAMINE HCL 10MG TABLET (100 CT)  |
2 |
Generic |
$3.00 | $9.00 | P |
IMIPRAMINE HCL 25MG TABLET (100 CT)  |
2 |
Generic |
$3.00 | $9.00 | P |
IMIPRAMINE HCL 50 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | P |
IMIQUIMOD 5% CREAM PACKET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:12 /30Days |
IMOVAX RABIES VACCINE  |
4 |
Non-Preferred Drug |
35% | 35% | P |
INCASSIA 0.35 MG TABLET [Sharobel 28-Day] ![Compare how all Medicare Part D PDP plans in AL cover INCASSIA 0.35 MG TABLET [Sharobel 28-Day].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$3.00 | $9.00 | None |
Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE  |
4 |
Non-Preferred Drug |
35% | 35% | P |
INCRUSE ELLIPTA 62.5 MCG INH  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:30 /30Days |
Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC  |
2 |
Generic |
$3.00 | $9.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INDAPAMIDE 2.5 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
INFANRIX DTAP VIAL  |
4 |
Non-Preferred Drug |
35% | 35% | None |
INLYTA 1 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
INLYTA 5 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
INTELENCE 100MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
Intelence 200mg/1  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
INTELENCE 25 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:120 /30Days |
INTRALIPID 20% IV FAT EMUL EMULSION  |
4 |
Non-Preferred Drug |
35% | 35% | P |
INTRALIPID 30% IV FAT EMUL  |
4 |
Non-Preferred Drug |
35% | 35% | P |
INTRON A 10 MILLION UNITS VIAL  |
5 |
Specialty Tier |
25% | N/A | None |
INTRON A 18 MILLION UNITS VIAL  |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INTRON A 25 MILLION UNIT/2.5ML VIAL  |
5 |
Specialty Tier |
25% | N/A | None |
INTRON A 50 MILLION UNITS VIAL  |
5 |
Specialty Tier |
25% | N/A | None |
INTRON A 6MMU/ML VIAL  |
4 |
Non-Preferred Drug |
35% | 35% | None |
INTROVALE 0.15-0.03 MG TABLET TBDSPK 3MO [Setlakin] ![Compare how all Medicare Part D PDP plans in AL cover INTROVALE 0.15-0.03 MG TABLET TBDSPK 3MO [Setlakin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 35% | Q:91 /91Days |
INVANZ 1GM VIAL  |
4 |
Non-Preferred Drug |
35% | 35% | None |
Invega Sustenna 117 mg/0.75mL Prefilled Syringe  |
5 |
Specialty Tier |
25% | N/A | Q:1 /28Days |
Invega Sustenna 156 mg/mL Prefilled Syringe  |
5 |
Specialty Tier |
25% | N/A | Q:1 /28Days |
Invega Sustenna 234 mg/1.5mL Prefilled Syringe  |
5 |
Specialty Tier |
25% | N/A | Q:2 /28Days |
Invega Sustenna 39 mg/0.25mL Prefilled Syringe  |
4 |
Non-Preferred Drug |
35% | 35% | None |
Invega Sustenna 78 mg/0.5mL Prefilled Syringe  |
5 |
Specialty Tier |
25% | N/A | Q:1 /28Days |
INVEGA TRINZA 273 MG/0.875 ML  |
5 |
Specialty Tier |
25% | N/A | Q:1 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVEGA TRINZA 410 MG/1.315 ML  |
5 |
Specialty Tier |
25% | N/A | Q:1 /90Days |
INVEGA TRINZA 546 MG/1.75 ML  |
5 |
Specialty Tier |
25% | N/A | Q:2 /90Days |
INVEGA TRINZA 819 MG/2.625 ML  |
5 |
Specialty Tier |
25% | N/A | Q:3 /90Days |
INVELTYS 1% EYE DROP Eye Dropper  |
4 |
Non-Preferred Drug |
35% | 35% | None |
INVIRASE 500MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:120 /30Days |
INVOKAMET 150-1,000 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:60 /30Days |
INVOKAMET 150-500 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:60 /30Days |
INVOKAMET 50-1,000 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:60 /30Days |
INVOKAMET 50-500 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:60 /30Days |
INVOKAMET XR 150-1,000 MG TAB  |
4 |
Non-Preferred Drug |
35% | 35% | Q:60 /30Days |
INVOKAMET XR 150-500 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVOKAMET XR 50-1,000 MG TAB  |
4 |
Non-Preferred Drug |
35% | 35% | Q:60 /30Days |
INVOKAMET XR 50-500 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:60 /30Days |
INVOKANA 100 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:30 /30Days |
INVOKANA 300 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | Q:30 /30Days |
IPOL VIAL 40;8;32; UNT  |
4 |
Non-Preferred Drug |
35% | 35% | None |
IPRAT-ALBUT 0.5-3(2.5) MG/3 ML  |
2 |
Generic |
$3.00 | $9.00 | P Q:540 /30Days |
IPRATROPIUM 0.06% SPRAY  |
2 |
Generic |
$3.00 | $9.00 | Q:30 /30Days |
IPRATROPIUM BR 0.02% SOLN  |
2 |
Generic |
$3.00 | $9.00 | P Q:300 /30Days |
IPRATROPIUM BROMIDE NASAL SPRAY  |
2 |
Generic |
$3.00 | $9.00 | Q:30 /30Days |
IRBESARTAN 150 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in AL cover IRBESARTAN 150 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:60 /30Days |
IRBESARTAN 300 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in AL cover IRBESARTAN 300 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IRBESARTAN 75 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in AL cover IRBESARTAN 75 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:60 /30Days |
IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide] ![Compare how all Medicare Part D PDP plans in AL cover IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:30 /30Days |
IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide] ![Compare how all Medicare Part D PDP plans in AL cover IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$1.00 | $3.00 | Q:30 /30Days |
IRESSA 250 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
ISENTRESS 100 MG POWDER PACKET  |
5 |
Specialty Tier |
25% | N/A | Q:180 /30Days |
ISENTRESS 100 MG TABLET CHEW  |
5 |
Specialty Tier |
25% | N/A | Q:180 /30Days |
ISENTRESS 25 MG TABLET CHEW  |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:180 /30Days |
ISENTRESS 400MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
ISENTRESS HD 600 MG TABLET  |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
ISIBLOOM 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in AL cover ISIBLOOM 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
ISONIAZID 100 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISONIAZID 300 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ISONIAZID 50MG/5ML SYRUP  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOSORBIDE DINITRATE 40MG TABLETS ER  |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
ISOSORBIDE DN 10 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOSORBIDE DN 20 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOSORBIDE DN 30 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOSORBIDE DN 5 MG TABLET  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOSORBIDE MN 10 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ISOSORBIDE MN ER 30 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ISOSORBIDE MN ER 60 MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
ISOSORBIDE MONONITRATE 20MG TABLET  |
2 |
Generic |
$3.00 | $9.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT)  |
2 |
Generic |
$3.00 | $9.00 | None |
ISOTON GENTAMICIN 80MG/100ML  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOTONIC GENTAMICIN 100 MG/100 ML  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOTONIC GENTAMICIN 80 MG/50 ML  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOTRETINOIN 10 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in AL cover ISOTRETINOIN 10 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOTRETINOIN 20 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in AL cover ISOTRETINOIN 20 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOTRETINOIN 30 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in AL cover ISOTRETINOIN 30 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISOTRETINOIN 40 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in AL cover ISOTRETINOIN 40 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISRADIPINE CAPSULES 2.5MG (100 CT)  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ISRADIPINE CAPSULES 5MG (100 CT)  |
4 |
Non-Preferred Drug |
35% | 35% | None |
ITRACONAZOLE 10 MG/ML SOLUTION [Sporanox] ![Compare how all Medicare Part D PDP plans in AL cover ITRACONAZOLE 10 MG/ML SOLUTION [Sporanox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ITRACONAZOLE 100 MG CAPSULE [Sporanox] ![Compare how all Medicare Part D PDP plans in AL cover ITRACONAZOLE 100 MG CAPSULE [Sporanox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
35% | 35% | P Q:120 /30Days |
IVERMECTIN 3 MG TABLET [Stromectol, Sklice] ![Compare how all Medicare Part D PDP plans in AL cover IVERMECTIN 3 MG TABLET [Stromectol, Sklice].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML  |
4 |
Non-Preferred Drug |
35% | 35% | None |