Cigna Healthcare Extra Rx (PDP) - S5617-270-000

2.5 out of 5 stars* for plan year 2025

$102.90

Monthly Premium

Cigna Healthcare Extra Rx (PDP) is a Medicare Part D Prescription Drug Plan offered by Cigna

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$102.90

Monthly Premium

Nebraska, Montana, North Dakota, South Dakota, Minnesota, Iowa, and Wyoming Medicare beneficiaries may want to consider reviewing their Medicare prescription drug coverage options, such as a standalone Part D prescription drug plan (PDP) or a Medicare Advantage (Medicare Part C) plan that includes drug coverage.

A Part D plan can be used alongside your Original Medicare (Part A and Part B) coverage. A Medicare Advantage plan that includes drug coverage combines your Part A, Part B and Part D benefits into a single plan

Learn more about Nebraska, Montana, North Dakota, South Dakota, Minnesota, Iowa, and Wyoming Medicare prescription drug plans like the one below and find a plan that offers the benefits you want at an affordable price.

Cigna Healthcare Extra Rx (PDP) - S5617-270-000 Basic Costs and Coverage

Coverage	Details
Monthly plan premium	$102.90
Annual deductible	$175.00
Preferred pharmacies?	Yes
Accepts Mail Order?	Yes
Star Rating	2.5 out of 5 stars

Prescription Drug Costs and Coverage

The Cigna Healthcare Extra Rx (PDP) is a prescription drug plan which offers the following coverage:

Deductible Coverage Level

30 day supply
60 day supply
90 day supply

Tiers	Tier 1 Preferred Generic Drug	Tier 2 Generic Drug
Preferred retail	$1.00	$10.00
Standard retail	$12.00	$20.00
Preferred mail order	$1.00	$10.00
Standard mail order	$12.00	$20.00

Tiers	Tier 1 Preferred Generic Drug	Tier 2 Generic Drug
Preferred retail	$2.00	$20.00
Standard retail	$24.00	$40.00
Preferred mail order	$2.00	$20.00
Standard mail order	$24.00	$40.00

Tiers	Tier 1 Preferred Generic Drug	Tier 2 Generic Drug
Preferred retail	$3.00	$30.00
Standard retail	$36.00	$60.00
Preferred mail order	$0.00	$6.00
Standard mail order	$36.00	$60.00

Initial Coverage Level

30 day supply
60 day supply
90 day supply

Tiers	Tier 1 Preferred Generic Drug	Tier 2 Generic Drug	Tier 3 Preferred Brand Drug	Tier 4 Non-Preferred Drug	Tier 5 Specialty Tier Drug
Preferred retail	$1.00	$10.00	19%	50%	31%
Standard retail	$12.00	$20.00	23%	50%	31%
Preferred mail order	$1.00	$10.00	19%	50%	31%
Standard mail order	$12.00	$20.00	23%	50%	31%

Tiers	Tier 1 Preferred Generic Drug	Tier 2 Generic Drug	Tier 3 Preferred Brand Drug	Tier 4 Non-Preferred Drug	Tier 5 Specialty Tier Drug
Preferred retail	$2.00	$20.00	19%	50%	N/A
Standard retail	$24.00	$40.00	23%	50%	N/A
Preferred mail order	$2.00	$20.00	19%	50%	N/A
Standard mail order	$24.00	$40.00	23%	50%	N/A

Tiers	Tier 1 Preferred Generic Drug	Tier 2 Generic Drug	Tier 3 Preferred Brand Drug	Tier 4 Non-Preferred Drug	Tier 5 Specialty Tier Drug
Preferred retail	$3.00	$30.00	19%	50%	N/A
Standard retail	$36.00	$60.00	23%	50%	N/A
Preferred mail order	$0.00	$6.00	19%	50%	N/A
Standard mail order	$36.00	$60.00	23%	50%	N/A

Eligibility & Enrollment

Costs & Coverage

News & Resources

Cigna Healthcare Extra Rx (PDP) - S5617-270-000

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Cigna Healthcare Extra Rx (PDP) - S5617-270-000 Basic Costs and Coverage

Prescription Drug Costs and Coverage

Plan Documents

Nebraska Counties Served

Montana Counties Served

North Dakota Counties Served

South Dakota Counties Served

Minnesota Counties Served

Iowa Counties Served

Wyoming Counties Served