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 
If you receive Extra Help for your drugs, you'll pay the following: 
Deductible You may pay  $0 or  $104 depending on your level of "Extra Help"  (for Tier 4, Tier 5) .If your 
deductible is  $104 ,you pay the full cost of these drugs until you reach  $104 .Then, you only pay your 
cost-share.