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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
Cick on the first letter of your drug name to browse the formulary:

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2019 Medicare Part D Plan Formulary Information
Cigna-HealthSpring Rx Secure-Essential (PDP) (S5617-291-0)
Benefit Details           
The Cigna-HealthSpring Rx Secure-Essential (PDP) (S5617-291-0)
Formulary Drugs Starting with the Letter N

in CMS PDP Region 12 which includes: AL TN
Plan Monthly Premium: $21.90 Deductible: $415 Qualifies for LIS: No
Drugs Starting with Letter N

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
NABUMETONE 500 MG TABLET   2* Generic $3.00$6.00None
NABUMETONE 750 MG TABLET   2* Generic $3.00$6.00None
NADOLOL 20 MG TABLET   4 Non-Preferred Drug 49%49%None
NADOLOL 40MG TABLETS   4 Non-Preferred Drug 49%49%None
NADOLOL 80 MG TABLET   4 Non-Preferred Drug 49%49%None
NADOLOL-BENDROFLU 40-5 MG TAB   4 Non-Preferred Drug 49%49%None
Nafcillin 1 gm vial   4 Non-Preferred Drug 49%49%None
NAFCILLIN 10 GM BULK VIAL   4 Non-Preferred Drug 49%49%None
NAFCILLIN 2 GM VIAL   4 Non-Preferred Drug 49%49%None
NAFTIFINE HCL 1% CREAM (g) [Naftin-MP]   4 Non-Preferred Drug 49%49%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NAFTIFINE HCL 2% CREAM [Naftin]   4 Non-Preferred Drug 49%49%None
NALOXONE 0.4 MG/ML VIAL   2* Generic $3.00$6.00None
naloxone 1 mg/ml syringe   3 Preferred Brand 20%20%None
NALTREXONE 50 MG TABLET   3 Preferred Brand 20%20%None
Naproxen 125 mg/5 ml suspen   4 Non-Preferred Drug 49%49%None
NAPROXEN 250 MG ORAL TABLET   2* Generic $3.00$6.00None
NAPROXEN 375 MG TABLET   1* Preferred Generic $1.00$2.00None
NAPROXEN 500 MG TABLET   1* Preferred Generic $1.00$2.00None
NAPROXEN DR 375 MG TABLET   2* Generic $3.00$6.00None
NAPROXEN DR 500 MG TABLET   2* Generic $3.00$6.00None
NAPROXEN SODIUM 275 MG TAB   4 Non-Preferred Drug 49%49%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NAPROXEN SODIUM 550 MG TAB   4 Non-Preferred Drug 49%49%None
NARATRIPTAN HCL 1 MG TABLET   4 Non-Preferred Drug 49%49%Q:9
/30Days
NARATRIPTAN HCL 2.5 MG TABLET   4 Non-Preferred Drug 49%49%Q:9
/30Days
NARCAN 4 MG NASAL SPRAY   3 Preferred Brand 20%20%Q:4
/30Days
NASONEX 50ug/1 120 SPRAY, METERED in 1 BOTTLE, PUMP   4 Non-Preferred Drug 49%49%S Q:34
/30Days
NATACYN EYE DROPS   4 Non-Preferred Drug 49%49%None
NATEGLINIDE 120 MG TABLET   2* Generic $3.00$6.00Q:90
/30Days
NATEGLINIDE 60 MG TABLET   2* Generic $3.00$6.00Q:90
/30Days
NATPARA 100 MCG DOSE CARTRIDGE   5 Specialty Tier 25%N/AP Q:2
/28Days
NATPARA 25 MCG DOSE CARTRIDGE   5 Specialty Tier 25%N/AP Q:2
/28Days
NATPARA 50 MCG DOSE CARTRIDGE   5 Specialty Tier 25%N/AP Q:2
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NATPARA 75 MCG DOSE CARTRIDGE   5 Specialty Tier 25%N/AP Q:2
/28Days
NEBUPENT 300MG INHAL POWDER   3 Preferred Brand 20%20%P Q:6
/28Days
NECON 0.5-35-28 TABLET   3 Preferred Brand 20%20%None
NEFAZODONE HCL 150MG TABLET (60 CT)   4 Non-Preferred Drug 49%49%Q:60
/30Days
NEFAZODONE HCL 250MG TABLET   4 Non-Preferred Drug 49%49%Q:60
/30Days
NEFAZODONE HCL 50MG TABLET   4 Non-Preferred Drug 49%49%Q:60
/30Days
NEFAZODONE HYDROCHLORIDE TABLETS 100MG 60 BOT   4 Non-Preferred Drug 49%49%Q:60
/30Days
NEFAZODONE HYDROCHLORIDE TABLETS 200MG 60 BOT   4 Non-Preferred Drug 49%49%Q:60
/30Days
NEO/POLYMYXIN/HC EAR TUBEX 10MG/3.5MG/100UNT   4 Non-Preferred Drug 49%49%None
NEOMYC-POLYM-DEXAMET EYE OINTM [Poly-Dex]   2* Generic $3.00$6.00None
NEOMYC-POLYM-DEXAMETH EYE DROP   2* Generic $3.00$6.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NEOMYCIN SULFATE 500MG TABLET   2* Generic $3.00$6.00None
NEOMYCIN-BACITRACIN-POLY-HC 3.5-10K-1 OINTMENT   4 Non-Preferred Drug 49%49%None
NEOMYCIN-POLYMYXIN-HC 3.5-10K-10 SUSPENSION DROPS   4 Non-Preferred Drug 49%49%None
NEOMYCIN/POLYMY/GRAM EYE DROPS 0.025MG/ML 1.75MG/M   2* Generic $3.00$6.00None
NEOMYCIN/POLYMY/HYDRO OTIC SUS   4 Non-Preferred Drug 49%49%None
NEPHRAMINE SOLUTION FOR INJECTION   4 Non-Preferred Drug 49%49%P
NERLYNX 40 MG TABLET   5 Specialty Tier 25%N/AP Q:180
/30Days
NEUPRO 1 MG/24 HR PATCH   4 Non-Preferred Drug 49%49%Q:30
/30Days
NEUPRO 2 MG/24 HR PATCH   4 Non-Preferred Drug 49%49%Q:30
/30Days
NEUPRO 3 MG/24 HR PATCH   4 Non-Preferred Drug 49%49%Q:30
/30Days
NEUPRO 4 MG/24 HR PATCH   4 Non-Preferred Drug 49%49%Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NEUPRO 6 MG/24 HR PATCH   4 Non-Preferred Drug 49%49%Q:30
/30Days
NEUPRO 8 MG/24 HR PATCH   4 Non-Preferred Drug 49%49%Q:30
/30Days
NEVIRAPINE 200 MG TABLET   4 Non-Preferred Drug 49%49%Q:60
/30Days
NEVIRAPINE 50 MG/5 ML SUSP Oral Suspension [Viramune]   4 Non-Preferred Drug 49%49%Q:1200
/30Days
NEVIRAPINE ER 100 MG TABLET   4 Non-Preferred Drug 49%49%Q:90
/30Days
NEVIRAPINE ER 400 MG TABLET   4 Non-Preferred Drug 49%49%Q:30
/30Days
NEXAVAR TABLETS 200MG 120 BOT   5 Specialty Tier 25%N/AP Q:120
/30Days
NIACIN ER 1,000 MG TABLET [Niaspan ER]   4 Non-Preferred Drug 49%49%Q:60
/30Days
NIACIN ER 500 MG TABLET [Niaspan ER]   4 Non-Preferred Drug 49%49%Q:30
/30Days
NIACIN ER 750 MG TABLET [Niaspan ER]   4 Non-Preferred Drug 49%49%Q:60
/30Days
NIACOR 500 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
NIASPAN ER 1,000 MG TABLET   4 Non-Preferred Drug 49%49%S Q:60
/30Days
NIASPAN ER 500 MG TABLET   4 Non-Preferred Drug 49%49%S Q:30
/30Days
NIASPAN ER 750 MG TABLET [Slo-Niacin]   4 Non-Preferred Drug 49%49%S Q:60
/30Days
Nicardipine hydrochloride 20 MG Oral Capsule   4 Non-Preferred Drug 49%49%None
Nicardipine hydrochloride 30 MG Oral Capsule   4 Non-Preferred Drug 49%49%None
NICOTROL INHALER 10MG 168 X 10MG/CARTRIDGE INHL   4 Non-Preferred Drug 49%49%Q:1008
/90Days
NICOTROL NS NASAL SPRAY BOTTLE 10MG 4 X 10MG/ML INHL   4 Non-Preferred Drug 49%49%Q:30
/30Days
NIFEDIPINE ER 30 MG TABLET   3 Preferred Brand 20%20%Q:60
/30Days
NIFEDIPINE ER 30 MG TABLET   3 Preferred Brand 20%20%Q:60
/30Days
NIFEDIPINE ER 60 MG TABLET   3 Preferred Brand 20%20%Q:60
/30Days
NIFEDIPINE ER 60 MG TABLET   3 Preferred Brand 20%20%Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NIFEDIPINE ER 90 MG TABLET   3 Preferred Brand 20%20%Q:30
/30Days
NIFEDIPINE ER 90 MG TABLET   3 Preferred Brand 20%20%Q:30
/30Days
NILUTAMIDE 150 MG TABLET [Nilandron]   5 Specialty Tier 25%N/AQ:60
/30Days
NIMODIPINE 30 MG CAPSULE   4 Non-Preferred Drug 49%49%None
NINLARO 2.3 MG CAPSULE   5 Specialty Tier 25%N/AP Q:3
/28Days
NINLARO 3 MG CAPSULE   5 Specialty Tier 25%N/AP Q:3
/28Days
NINLARO 4 MG CAPSULE   5 Specialty Tier 25%N/AP Q:3
/28Days
NISOLDIPINE ER 17 MG TABLET 24H [Sular]   4 Non-Preferred Drug 49%49%Q:30
/30Days
NISOLDIPINE ER 20 MG TABLET 24H [Sular]   4 Non-Preferred Drug 49%49%None
NISOLDIPINE ER 25.5 MG TABLET 24H [Sular]   4 Non-Preferred Drug 49%49%Q:30
/30Days
NISOLDIPINE ER 30 MG TABLET 24H [Sular]   4 Non-Preferred Drug 49%49%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NISOLDIPINE ER 34 MG TABLET 24H [Sular]   4 Non-Preferred Drug 49%49%Q:30
/30Days
NISOLDIPINE ER 40 MG TABLET 24H [Sular]   4 Non-Preferred Drug 49%49%None
NISOLDIPINE ER 8.5 MG TABLET 24H [Sular]   4 Non-Preferred Drug 49%49%Q:30
/30Days
Nitrofurantoin 25mg/5mL   4 Non-Preferred Drug 49%49%None
NITROFURANTOIN MACROCRYSTALLINE 50 mg cap   4 Non-Preferred Drug 49%49%None
NITROFURANTOIN MCR 100 MG CAPSULE [Macrodantin]   4 Non-Preferred Drug 49%49%None
NITROFURANTOIN MCR 25 MG CAP   4 Non-Preferred Drug 49%49%None
NITROFURANTOIN MONO-MCR 100 MG CAPSULE [Macrobid]   3 Preferred Brand 20%20%None
NITROGLYCERIN 0.2 MG/HR PATCH   2* Generic $3.00$6.00Q:30
/30Days
NITROGLYCERIN 0.3 MG TABLET SL   2* Generic $3.00$6.00None
NITROGLYCERIN 0.4 MG TABLET SL   2* Generic $3.00$6.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NITROGLYCERIN 0.4 MG/HR PATCH   2* Generic $3.00$6.00Q:30
/30Days
NITROGLYCERIN 0.6 MG TABLET SL   2* Generic $3.00$6.00None
NITROGLYCERIN 0.6 MG/HR PATCH   2* Generic $3.00$6.00Q:30
/30Days
NITROGLYCERIN LINGUAL 0.4 MG   4 Non-Preferred Drug 49%49%None
NITROGLYCERIN TRANSOERMAL SYSTEM .1MG/HR 30 SYSTEM BOX   2* Generic $3.00$6.00Q:30
/30Days
NORA-BE 0.35MG TABLET   2* Generic $3.00$6.00None
NORETHIN-ETH ESTRAD 0.5-2.5   4 Non-Preferred Drug 49%49%P
NORETHIND-ETH ESTRAD 1-0.02 MG   2* Generic $3.00$6.00None
NORETHINDRONE 0.35 MG TABLET   2* Generic $3.00$6.00None
NORETHINDRONE 5MG TABLET   2* Generic $3.00$6.00None
NORG-EE 0.18-0.215-0.25/0.035   2* Generic $3.00$6.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NORG-ETHIN ESTRA 0.25-0.035 MG   3 Preferred Brand 20%20%None
Norlyroc 0.35 mg tablet   3 Preferred Brand 20%20%None
NORMOSOL -R INJ /D5W   4 Non-Preferred Drug 49%49%P
NORMOSOL-M AND DEXTROSE 5%   4 Non-Preferred Drug 49%49%P
NORMOSOL-R PH 7.4 IV SOLUTION   4 Non-Preferred Drug 49%49%P
NORTHERA 100 MG CAPSULE   5 Specialty Tier 25%N/AP Q:90
/30Days
NORTHERA 200 MG CAPSULE   5 Specialty Tier 25%N/AP Q:180
/30Days
NORTHERA 300 MG CAPSULE   5 Specialty Tier 25%N/AP Q:180
/30Days
Nortrel (21 Day Regimen) 0.035; 1mg/1; mg/1 3 BLISTER PACK per CARTON / 21 TABLET per BLISTER PACK   2* Generic $3.00$6.00None
Nortrel (28 Day Regimen) 3 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK   2* Generic $3.00$6.00None
NORTREL 1-0.035MG TABLET 28DAY   2* Generic $3.00$6.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Nortrel 7/7/7 (28 Day Regimen) 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER   2* Generic $3.00$6.00None
NORTRIPTYLINE 10 MG/5 ML SOL   2* Generic $3.00$6.00None
NORTRIPTYLINE HCL 25MG CAP   2* Generic $3.00$6.00None
NORTRIPTYLINE HCL 50 MG CAP   2* Generic $3.00$6.00None
NORTRIPTYLINE HCL 75 MG CAP   2* Generic $3.00$6.00None
Nortriptyline Hydrochloride 10mg/1 100 CAPSULE BOTTLE   2* Generic $3.00$6.00None
NORVIR 100 MG POWDER PACKET   4 Non-Preferred Drug 49%49%Q:360
/30Days
NORVIR 80MG/ML ORAL SOLUTION   3 Preferred Brand 20%20%Q:480
/30Days
NOXAFIL 200MG/5ML SUSPENSION ORAL   5 Specialty Tier 25%N/AP Q:600
/30Days
NOXAFIL DR 100 MG TABLET   5 Specialty Tier 25%N/AP Q:96
/30Days
NUEDEXTA 20; 10mg/1; mg/1   4 Non-Preferred Drug 49%49%P Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
NUPLAZID 10 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
NUPLAZID 34 MG CAPSULE   5 Specialty Tier 25%N/AP Q:30
/30Days
NUTRILIPID 20 % EMULSION   4 Non-Preferred Drug 49%49%P
NUZYRA 100 MG VIAL   4 Non-Preferred Drug 49%49%Q:15
/14Days
NUZYRA 150 MG TABLET   4 Non-Preferred Drug 49%49%Q:30
/14Days
NUZYRA 150 MG TABLET-7 DAY   4 Non-Preferred Drug 49%49%Q:30
/14Days
NUZYRA 150 MG-7 DAY WITH LOAD TABLET   4 Non-Preferred Drug 49%49%Q:30
/14Days
NYAMYC 100,000 UNITS/GM POWDER   4 Non-Preferred Drug 49%49%None
NYSTATIN 100,000 UNIT/GM CREAM (g) [Pediaderm AF]   2* Generic $3.00$6.00None
NYSTATIN 100,000 UNIT/GM POWD   3 Preferred Brand 20%20%None
NYSTATIN 100,000 UNITS/GM OINT   2* Generic $3.00$6.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Nystatin 100000[USP'U]/mL   2* Generic $3.00$6.00None
NYSTATIN 500,000 UNIT ORAL TAB   2* Generic $3.00$6.00None
NYSTATIN/TRIAMCINOLONE CRM   4 Non-Preferred Drug 49%49%None
NYSTATIN/TRIAMCINOLONE OINT 10000UNT/1MG   4 Non-Preferred Drug 49%49%None
NYSTOP 100,000 UNITS/GM POWDER   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.