Humana Value Rx Plan (PDP)
Contract S5884, plan 196, segment 0 · offered by Humana Insurance Co. & Humana Insurance Co. of NY · CMS PDP Region 17 (Illinois).
Plan features
| Monthly premium | $0.00 |
|---|---|
| Annual deductible | $601.00Tier 1 and 2 exempt |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,079 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Illinois | 145,551 |
| Members nationally | 145,935 |
| Member services | (800)281-6918TTY 711 |
| Pharmacy search | www.humana.com/pharmacy/ |
| BIN / PCN | 015581 / 03200000See BIN/PCNs for all plans |
CMS star ratings
- Part D summary rating
- 3 out of 5 stars for Part D summary rating
Published per contract, which is how CMS scores them — every plan under contract S5884 shares this rating.
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $0.00 | 314 |
| Tier 2 | $0.00 | 613 |
| Tier 3 | 20% | 584 |
| Tier 4 | 35% | 943 |
| Tier 5 | 26% | 625 |
Cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $1.00 | $0.00 | $0.00 | $3.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $1.00 | $0.00 | $0.00 | $3.00 | $0.00 |
| Tier 3: Preferred Brand | 20% | 20% | 15% | 20% | 20% | 15% |
| Tier 4: Non-Preferred Drug | 35% | 35% | 35% | n/a | n/a | n/a |
| Tier 5: Specialty Tier | 26% | 26% | 26% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Plan facts come from the CMS quarterly prescription drug plan public use files.