Tier 6: Select Care Drugs $0 $0 $0 $0 12 Summary of Benefits H1036234000SB23 H1036234000 
Retail Cost-Sharing 
Pharmacy options Retail All network retail pharmacies. To find the retail pharmacies near 
you, go to  Humana.com/pharmacyfinder 
N/A 30-day supply 90-day supply* 
Tier 1: Preferred Generic $0 $0 
Tier 2: Generic $0 $0 
Tier 3: Preferred Brand $42 $126 
Tier 4: Non-Preferred 
Drug $100 $300 
Tier 5: Specialty Tier 33% N/A 
Tier 6: Select Care Drugs $0 $0