Cigna Extra Rx (PDP)

Cigna
Cigna Extra Rx (PDP) S5617-261 Plan Details
3 out of 5 stars

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-261.

$55.90
Monthly Premium

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-261.

Cigna
Cigna Extra Rx (PDP) S5617-261 Plan Details
3 out of 5 stars

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-261.

$55.90
Monthly Premium

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