Retail Cost-Sharing for Select Insulins 
Pharmacy 
options  Retail  
All network retail pharmacies. To find the retail pharmacies near you, go 
to  Humana.com/pharmacyfinder 
- 30-day supply  90-day supply* 
Tier 3: Preferred Brand  $35 $105 H1036234000SB23 Summary of Benefits 13 H1036234000 
If you receive Extra Help for your drugs, you'll pay the following: 
Deductible  This plan does not have adeductible. 
Pharmacy cost-sharing 
For generic drugs 
(including  30-day supply 90-day supply*