Cigna Extra Rx (PDP)

Cigna Extra Rx (PDP) S5617-254 Plan Details

3 out of 5 stars

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-254.

^$69.70

Monthly Premium

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-254.

Cigna Extra Rx (PDP) S5617-254 Plan Details

3 out of 5 stars

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-254.

^$69.70

Monthly Premium

South Carolina Counties Served

Abbeville Aiken Anderson Beaufort Berkeley Chesterfield York Allendale Bamberg Barnwell Calhoun Charleston Cherokee Chester Clarendon Colleton Darlington Dillon Dorchester Edgefield Fairfield Florence Georgetown Greenville Greenwood Hampton Horry Jasper Kershaw Lancaster Laurens Lee Lexington Marion Marlboro Mccormick Newberry Oconee Orangeburg Pickens Richland Saluda Spartanburg Sumter Union Williamsburg

Basic Costs and Coverage

Coverage	Cost
Monthly Deductible	$100
Out of Pocket Max	In-Network: $-1 Out-of-Network: N/A
Initial Coverage Limit	$4660
Catastrophic Coverage Limit	$7,400

Prescription Drug Costs and Coverage

The Cigna Extra Rx (PDP) plan offers the following prescription drug coverage, with an annual drug deductible of $100 (excludes Tiers 1, 2, 3 and 6) per year.

Coverage	Cost
Coverage & Cost
Annual Drug Deductible	$100 (excludes Tiers 1, 2, 3 and 6)
Preferred Generic	Preferred cost-share retail $4.00 Standard retail $15.00 Preferred cost-share mail order $4.00 Standard mail order $15.00
Generic	Preferred cost-share retail $10.00 Standard retail $20.00 Preferred cost-share mail order $10.00 Standard mail order $20.00
Preferred Brand	Preferred cost-share retail $45.00 Standard retail $47.00 Preferred cost-share mail order $45.00 Standard mail order $47.00
Select Care Drugs	Preferred cost-share retail $0.00 Standard retail $11.00 Preferred cost-share mail order $0.00 Standard mail order $11.00
Annual Drug Deductible	$100 (excludes Tiers 1, 2, 3 and 6)
Preferred Generic	Preferred cost-share retail $8.00 Standard retail $30.00 Preferred cost-share mail order $8.00 Standard mail order $30.00
Generic	Preferred cost-share retail $20.00 Standard retail $40.00 Preferred cost-share mail order $20.00 Standard mail order $40.00
Preferred Brand	Preferred cost-share retail $90.00 Standard retail $94.00 Preferred cost-share mail order $90.00 Standard mail order $94.00
Select Care Drugs	Preferred cost-share retail $0.00 Standard retail $22.00 Preferred cost-share mail order $0.00 Standard mail order $22.00
Annual Drug Deductible	$100 (excludes Tiers 1, 2, 3 and 6)
Preferred Generic	Preferred cost-share retail $12.00 Standard retail $45.00 Preferred cost-share mail order $0.00 Standard mail order $45.00
Generic	Preferred cost-share retail $30.00 Standard retail $60.00 Preferred cost-share mail order $2.00 Standard mail order $60.00
Preferred Brand	Preferred cost-share retail $135.00 Standard retail $141.00 Preferred cost-share mail order $135.00 Standard mail order $141.00
Select Care Drugs	Preferred cost-share retail $0.00 Standard retail $33.00 Preferred cost-share mail order $0.00 Standard mail order $33.00

Back to Plans in South Carolina

Cigna Extra Rx (PDP)

South Carolina Counties Served

Basic Costs and Coverage

Prescription Drug Costs and Coverage

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Cigna Extra Rx (PDP)

South Carolina Counties Served

Basic Costs and Coverage

Prescription Drug Costs and Coverage

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