Cigna Extra Rx (PDP)

Cigna Extra Rx (PDP) S5617-257 Plan Details

3 out of 5 stars

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-257.

^$63.10

Monthly Premium

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-257.

Cigna Extra Rx (PDP) S5617-257 Plan Details

3 out of 5 stars

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-257.

^$63.10

Monthly Premium

Alabama Counties Served

Autauga Baldwin Barbour Bibb Chambers Cherokee Colbert Fayette Blount Bullock Butler Calhoun Chilton Choctaw Clarke Clay Cleburne Coffee Conecuh Coosa Covington Crenshaw Cullman Dade Dale Dallas De Kalb Elmore Escambia Etowah Franklin Geneva Greene Hale Henry Houston Jackson Jefferson Lamar Lauderdale Lawrence Lee Lowndes Macon Madison Marengo Marion Marshall Mobile Monroe Montgomery Noxubee Perry Pickens Pike Randolph Russell Saint Clair Shelby Sumter Talladega Tallapoosa Tuscaloosa Walker Washington Wilcox Winston

Tennessee Counties Served

Anderson Bedford Benton Bledsoe Cannon Blount Bradley Campbell Carroll Carter Cheatham Chester Claiborne Clay Cocke Coffee Crockett Cumberland Davidson Decatur Dekalb Dickson Dyer Fayette Fentress Franklin Gibson Giles Grainger Greene Grundy Hamblen Hamilton Hancock Hardeman Hardin Hawkins Haywood Henderson Henry Hickman Houston Humphreys Jackson Jefferson Johnson Knox Lake Lauderdale Lawrence Lewis Lincoln Loudon Macon Madison Marion Marshall Maury Mcminn Mcnairy Meigs Monroe Montgomery Moore Morgan Obion Overton Perry Pickett Polk Putnam Rhea Roane Robertson Rutherford Scott Sequatchie Sevier Shelby Smith Stewart Sullivan Sumner Tipton Trousdale Unicoi Union Van Buren Warren Washington Wayne Weakley White Williamson Wilson

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

Cigna Extra Rx (PDP)

Alabama Counties Served

Tennessee Counties Served

Basic Costs and Coverage

Prescription Drug Costs and Coverage

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