2015 Stand-Alone Prescription Drug Plans with 2016 Plan Name Changes (with Membership Affected) |
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Plan Name 2015 | Plan Name 2016 | States | Members Affected |
Symphonix Rite Aid Premier Rx (PDP) | Symphonix PrimeSaver Rx (PDP) | many states (Ex: AL) | 953 |
Symphonix Premier Rx (PDP) | Symphonix PrimeSaver Rx (PDP) | many states (Ex: TX) | 1,467 |
Symphonix Rite Aid Value Rx (PDP) | Symphonix Value Rx (PDP) | many states (Ex: CA) | 137,700 |
MedBlue Rx (PDP) | BlueCross Rx Value (PDP) | SC | 13,566 |
MedBlue Rx Plus (PDP) | BlueCross Rx Plus (PDP) | SC | 6,779 |
Cigna-HealthSpring Rx Secure-Xtra (PDP) | Cigna-HealthSpring Rx Secure-Extra (PDP) | all states (Ex: FL) |
482,990 |
Pennsylvania 2015 Cigna-HealthSpring Rx Secure-Max Members Reassigned to 2016 Cigna-HealthSpring Rx Secure-Extra (PDP) |
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2015 Secure-Max |
2015 Secure-Xtra |
2016 Secure-Extra |
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Monthly Premium | $124.50 | $35.80 | $60.50 | |||
Initial Deductible | $0 | $0 | $250 | |||
Cost Sharing |
Nbr of Drugs |
Cost Sharing |
Nbr of Drugs |
Cost Sharing |
Nbr of Drugs |
|
Tier 1 Cost-Sharing | $1.00 | 293 | $1.00 | 293 | $1.00 | 290 |
Tier 2 Cost-Sharing | $2.00 | 1,570 | $4.00 | 1,569 | $5.00 | 1,523 |
Tier 3 Cost-Sharing | $30.00 | 522 |
20% | 446 | 20% | 448 |
Tier 4 Cost-Sharing | $85.00 | 541 | 35% | 647 | 43% | 613 |
Tier 5 Cost-Sharing |
33% |
418 |
33% | 424 |
27% |
439 |
Total Formulary Drugs | 3,344 | 3,379 | 3,310 |