•Two-month supply (31-60 days) 
•Three-month supply (61-90 days) 
*Long term care pharmacy (one-month supply =31 days) 2022 - 13 - Summary of Benefits H1036265001 
Coverage Gap 
After you enter the coverage gap, you pay  25 percent of the plan's cost for covered brand name drugs 
and  25 percent of the plan's cost for covered generic drugs until your costs total  $7,050 —which is the 
end of the coverage gap. As part of the Insulin Savings Program, you will pay no more than $35 for a