Tier 1: Preferred Generic $10 $30 $5 $0 
Tier 2: Generic $20 $60 $15 $0 
Tier 3: Preferred Brand $47 $141 $47 $131 
Tier 4: Non-Preferred 
Drug $100 $300 $97 $281 
Tier 5: Specialty Tier 29% N/A 29% N/A 
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 $5 $15 
Tier 2: Generic $15 $45 
Tier 3: Preferred Brand $47 $141 
Tier 4: Non-Preferred