Cigna Extra Rx (PDP)

Cigna Extra Rx (PDP) S5617-264 Plan Details

3 out of 5 stars

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-264.

^$67.30

Monthly Premium

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-264.

Cigna Extra Rx (PDP) S5617-264 Plan Details

3 out of 5 stars

Cigna Extra Rx (PDP) is a plan offered by Cigna.
Plan ID: S5617-264.

^$67.30

Monthly Premium

Arkansas Counties Served

Arkansas Ashley Benton Bradley Baxter Boone Calhoun Carroll Chicot Clark Clay Cleburne Cleveland Columbia Conway Craighead Crawford Crittenden Cross Dallas Desha Drew Faulkner Franklin Fulton Garland Grant Greene Hempstead Hot Spring Howard Independence Izard Jackson Jefferson Johnson Lafayette Lawrence Le Flore Lee Little River Logan Lonoke Madison Mccurtain Miller Mississippi Monroe Montgomery Nevada Newton Ouachita Perry Phillips Pike Poinsett Polk Pope Prairie Pulaski Randolph Saint Francis Saline Scott Searcy Sebastian Sevier Sharp Stone Union Van Buren Washington White Woodruff Yell

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 Arkansas

Cigna Extra Rx (PDP)

Arkansas Counties Served

Basic Costs and Coverage

Prescription Drug Costs and Coverage

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