CenterWell Pharmacy ™
N/A 30-day supply 90-day supply* 30-day supply 90-day supply* 
Tier 1: Preferred Generic $10 $30 $0 $0 
Tier 2: Generic $20 $60 $0 $0 
Tier 3: Preferred Brand $47 $141 $42 $116 
Tier 4: Non-Preferred 
Drug $100 $300 $100 $290 
Tier 5: Specialty Tier 33% N/A 33% N/A 12 Summary of Benefits H1036236000SB23 H1036236000 
Retail Cost-Sharing 
Pharmacy options Retail All network retail pharmacies. To find the retail pharmacies near 
you, go to  Humana.com/pharmacyfinder