Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community
  • Home
  • Contact
  • MAPD
  • PDP
  • 2020
  • FAQs
  • Articles
  • Search
  • Contact
  • 2020
  • FAQs
  • Articles
  • Latest Medicare News
  • Search


2019 Medicare Part D and Medicare Advantage Plan Formulary Browser

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

Cigna-HealthSpring Rx Secure-Essential (PDP) (S5617-291-0)
Tier 1 (171)
Tier 2 (751)
Tier 3 (445)
Tier 4 (1362)
Tier 5 (510)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the 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 
2019 Medicare Part D Plan Formulary Information
Cigna-HealthSpring Rx Secure-Essential (PDP) (S5617-291-0)
Benefits & Contact Info           
The Cigna-HealthSpring Rx Secure-Essential (PDP) (S5617-291-0)
Formulary Drugs Starting with the Letter I

in CMS PDP Region 12 which includes: AL TN
Plan Monthly Premium: $21.90 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]   3 Preferred Brand 20%20%Q:1
/28Days
IBRANCE 100 MG CAPSULE   5 Specialty Tier 25%N/AP Q:21
/28Days
IBRANCE 125 MG CAPSULE   5 Specialty Tier 25%N/AP Q:21
/28Days
IBRANCE 75 MG CAPSULE   5 Specialty Tier 25%N/AP Q:21
/28Days
Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE   2* Generic $3.00$6.00None
IBUPROFEN 400 MG TABLET   1* Preferred Generic $1.00$2.00None
IBUPROFEN 600 MG ORAL TABLET   1* Preferred Generic $1.00$2.00None
IBUPROFEN 600mg/1 500 TABLET BOTTLE   1* Preferred Generic $1.00$2.00None
IBUPROFEN 800 MG ORAL TABLET   1* Preferred Generic $1.00$2.00None
IBUPROFEN 800 MG TABLET   1* Preferred Generic $1.00$2.00None
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/AP Q:60
/30Days
ICLUSIG 45 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
IDHIFA 100 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
IDHIFA 50 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
IMATINIB MESYLATE 100 MG TAB [Gleevec]   5 Specialty Tier 25%N/AP Q:60
/30Days
IMATINIB MESYLATE 400 MG TAB [Gleevec]   5 Specialty Tier 25%N/AP Q:60
/30Days
IMBRUVICA 140 MG CAPSULE   5 Specialty Tier 25%N/AP Q:120
/30Days
IMBRUVICA 140 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
IMBRUVICA 280 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
IMBRUVICA 420 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
IMBRUVICA 560 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
IMBRUVICA 70 MG CAPSULE   5 Specialty Tier 25%N/AP Q:30
/30Days
IMIPRAMINE HCL 10MG TABLET (100 CT)   2* Generic $3.00$6.00P
IMIPRAMINE HCL 25MG TABLET (100 CT)   2* Generic $3.00$6.00P
IMIPRAMINE HCL 50 MG TABLET   2* Generic $3.00$6.00P
IMIQUIMOD 5% CREAM PACKET   4 Non-Preferred Drug 49%49%Q:12
/30Days
IMOVAX RABIES VACCINE   4 Non-Preferred Drug 49%49%P
INCASSIA 0.35 MG TABLET [Sharobel 28-Day]   2* Generic $3.00$6.00None
Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE   4 Non-Preferred Drug 49%49%P
INCRUSE ELLIPTA 62.5 MCG INH   3 Preferred Brand 20%20%Q:30
/30Days
Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC   2* Generic $3.00$6.00None
INDAPAMIDE 2.5 MG TABLET   2* Generic $3.00$6.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
INFANRIX DTAP VIAL   4 Non-Preferred Drug 49%49%None
INLYTA 1 MG TABLET   5 Specialty Tier 25%N/AP Q:120
/30Days
INLYTA 5 MG TABLET   5 Specialty Tier 25%N/AP Q:120
/30Days
INTELENCE 100MG TABLET   5 Specialty Tier 25%N/AQ:60
/30Days
Intelence 200mg/1   5 Specialty Tier 25%N/AQ:60
/30Days
INTELENCE 25 MG TABLET   4 Non-Preferred Drug 49%49%Q:120
/30Days
INTRALIPID 20% IV FAT EMUL EMULSION   4 Non-Preferred Drug 49%49%P
INTRALIPID 30% IV FAT EMUL   4 Non-Preferred Drug 49%49%P
INTRON A 10 MILLION UNITS VIAL   5 Specialty Tier 25%N/ANone
INTRON A 18 MILLION UNITS VIAL   5 Specialty Tier 25%N/ANone
INTRON A 25 MILLION UNIT/2.5ML VIAL   5 Specialty Tier 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
INTRON A 50 MILLION UNITS VIAL   5 Specialty Tier 25%N/ANone
INTRON A 6MMU/ML VIAL   4 Non-Preferred Drug 49%49%None
INTROVALE 0.15-0.03 MG TABLET TBDSPK 3MO [Setlakin]   4 Non-Preferred Drug 49%49%Q:91
/91Days
INVANZ 1GM VIAL   4 Non-Preferred Drug 49%49%None
Invega Sustenna 117 mg/0.75mL Prefilled Syringe   5 Specialty Tier 25%N/AQ:1
/28Days
Invega Sustenna 156 mg/mL Prefilled Syringe   5 Specialty Tier 25%N/AQ:1
/28Days
Invega Sustenna 234 mg/1.5mL Prefilled Syringe   5 Specialty Tier 25%N/AQ:2
/28Days
Invega Sustenna 39 mg/0.25mL Prefilled Syringe   4 Non-Preferred Drug 49%49%None
Invega Sustenna 78 mg/0.5mL Prefilled Syringe   5 Specialty Tier 25%N/AQ:1
/28Days
INVEGA TRINZA 273 MG/0.875 ML   5 Specialty Tier 25%N/AQ:1
/90Days
INVEGA TRINZA 410 MG/1.315 ML   5 Specialty Tier 25%N/AQ:1
/90Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
INVEGA TRINZA 546 MG/1.75 ML   5 Specialty Tier 25%N/AQ:2
/90Days
INVEGA TRINZA 819 MG/2.625 ML   5 Specialty Tier 25%N/AQ:3
/90Days
INVELTYS 1% EYE DROP Eye Dropper   4 Non-Preferred Drug 49%49%None
INVIRASE 500MG TABLET   5 Specialty Tier 25%N/AQ:120
/30Days
INVOKAMET 150-1,000 MG TABLET   4 Non-Preferred Drug 49%49%Q:60
/30Days
INVOKAMET 150-500 MG TABLET   4 Non-Preferred Drug 49%49%Q:60
/30Days
INVOKAMET 50-1,000 MG TABLET   4 Non-Preferred Drug 49%49%Q:60
/30Days
INVOKAMET 50-500 MG TABLET   4 Non-Preferred Drug 49%49%Q:60
/30Days
INVOKAMET XR 150-1,000 MG TAB   4 Non-Preferred Drug 49%49%Q:60
/30Days
INVOKAMET XR 150-500 MG TABLET   4 Non-Preferred Drug 49%49%Q:60
/30Days
INVOKAMET XR 50-1,000 MG TAB   4 Non-Preferred Drug 49%49%Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
INVOKAMET XR 50-500 MG TABLET   4 Non-Preferred Drug 49%49%Q:60
/30Days
INVOKANA 100 MG TABLET   4 Non-Preferred Drug 49%49%Q:30
/30Days
INVOKANA 300 MG TABLET   4 Non-Preferred Drug 49%49%Q:30
/30Days
IPOL VIAL 40;8;32; UNT   4 Non-Preferred Drug 49%49%None
IPRAT-ALBUT 0.5-3(2.5) MG/3 ML   2* Generic $3.00$6.00P Q:540
/30Days
IPRATROPIUM 0.06% SPRAY   2* Generic $3.00$6.00Q:30
/30Days
IPRATROPIUM BR 0.02% SOLN   2* Generic $3.00$6.00P Q:300
/30Days
IPRATROPIUM BROMIDE NASAL SPRAY   2* Generic $3.00$6.00Q:30
/30Days
IRBESARTAN 150 MG TABLET [Avapro]   1* Preferred Generic $1.00$2.00Q:60
/30Days
IRBESARTAN 300 MG TABLET [Avapro]   1* Preferred Generic $1.00$2.00Q:30
/30Days
IRBESARTAN 75 MG TABLET [Avapro]   1* Preferred Generic $1.00$2.00Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide]   1* Preferred Generic $1.00$2.00Q:30
/30Days
IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide]   1* Preferred Generic $1.00$2.00Q:30
/30Days
IRESSA 250 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
ISENTRESS 100 MG POWDER PACKET   5 Specialty Tier 25%N/AQ:180
/30Days
ISENTRESS 100 MG TABLET CHEW   5 Specialty Tier 25%N/AQ:180
/30Days
ISENTRESS 25 MG TABLET CHEW   3 Preferred Brand 20%20%Q:180
/30Days
ISENTRESS 400MG TABLET   5 Specialty Tier 25%N/AQ:60
/30Days
ISENTRESS HD 600 MG TABLET   5 Specialty Tier 25%N/AQ:60
/30Days
ISIBLOOM 28 DAY TABLET [Solia]   3 Preferred Brand 20%20%None
ISONIAZID 100 MG TABLET   2* Generic $3.00$6.00None
ISONIAZID 300 MG TABLET   2* Generic $3.00$6.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ISONIAZID 50MG/5ML SYRUP   4 Non-Preferred Drug 49%49%None
ISOSORBIDE DINITRATE 40MG TABLETS ER   3 Preferred Brand 20%20%None
ISOSORBIDE DN 10 MG TABLET   4 Non-Preferred Drug 49%49%None
ISOSORBIDE DN 20 MG TABLET   4 Non-Preferred Drug 49%49%None
ISOSORBIDE DN 30 MG TABLET   4 Non-Preferred Drug 49%49%None
ISOSORBIDE DN 5 MG TABLET   4 Non-Preferred Drug 49%49%None
ISOSORBIDE MN 10 MG TABLET   2* Generic $3.00$6.00None
ISOSORBIDE MN ER 30 MG TABLET   2* Generic $3.00$6.00None
ISOSORBIDE MN ER 60 MG TABLET   2* Generic $3.00$6.00None
ISOSORBIDE MONONITRATE 20MG TABLET   2* Generic $3.00$6.00None
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT)   2* Generic $3.00$6.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ISOTON GENTAMICIN 80MG/100ML   4 Non-Preferred Drug 49%49%None
ISOTONIC GENTAMICIN 100 MG/100 ML   4 Non-Preferred Drug 49%49%None
ISOTONIC GENTAMICIN 80 MG/50 ML   4 Non-Preferred Drug 49%49%None
ISOTRETINOIN 10 MG CAPSULE [ZENATANE]   4 Non-Preferred Drug 49%49%None
ISOTRETINOIN 20 MG CAPSULE [ZENATANE]   4 Non-Preferred Drug 49%49%None
ISOTRETINOIN 30 MG CAPSULE [ZENATANE]   4 Non-Preferred Drug 49%49%None
ISOTRETINOIN 40 MG CAPSULE [ZENATANE]   4 Non-Preferred Drug 49%49%None
ISRADIPINE CAPSULES 2.5MG (100 CT)   4 Non-Preferred Drug 49%49%None
ISRADIPINE CAPSULES 5MG (100 CT)   4 Non-Preferred Drug 49%49%None
ITRACONAZOLE 10 MG/ML SOLUTION [Sporanox]   5 Specialty Tier 25%N/AP
ITRACONAZOLE 100 MG CAPSULE [Sporanox]   4 Non-Preferred Drug 49%49%P Q:120
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
IVERMECTIN 3 MG TABLET [Stromectol, Sklice]   3 Preferred Brand 20%20%None
IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML   4 Non-Preferred Drug 49%49%None

Chart Legend:

Below are a few notes to help you understand the above 2019 Medicare Part D Cigna-HealthSpring Rx Secure-Essential (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region). The plan name is followed by the plan type (PDP, HMO, HMO-POS, PPO, PFFS, etc.)

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the standard $415 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons with the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have five (5) tiers 1=Preferred Generics, 2=Generics, 3=Preferred Brands, 4=Non-preferred Brands, 5=Specialty Drugs. *Some Part D plans exclude one or more drug tiers from the deductible. If the drug tier field above is followed by * (example: 2*), then this drug tier is excluded from the plan’s deductible.
    • Tier Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $3820) at a "Preferred" network pharmacy. In most cases, the "Preferred" network pharmacy cost-sharing is lower than the standard (non-preferred) network pharmacy cost-sharing.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2019 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.








Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.