Mail Order Cost-Sharing 
Pharmacy options Standard  
Walmart Mail ,PillPack 
Other pharmacies are 
available in our network. To find 
pharmacy mail order options go to  
Humana.com/pharmacyfinder Preferred 
CenterWell Pharmacy ™
N/A 30-day supply 90-day supply* 30-day supply 90-day supply* 
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