Humana Basic Rx Plan (PDP)

Contract S5884, plan 104, segment 0 · offered by Humana Insurance Co. & Humana Insurance Co. of NY · CMS PDP Region 06 (West Virginia).

Plan features

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$1.00	$1.00	$0.00	$3.00	$3.00	$0.00
Tier 3: Preferred Brand	25%	25%	20%	25%	25%	20%
Tier 4: Non-Preferred Drug	33%	33%	33%	n/a	n/a	n/a
Tier 5: Specialty Tier	25%	25%	25%	n/a	n/a	n/a
Catastrophic coverage phase
Tier 1: Preferred Generic	0%	0%	0%	0%	0%	0%
Tier 2: Generic	0%	0%	0%	0%	0%	0%
Tier 3: Preferred Brand	0%	0%	0%	0%	0%	0%
Tier 4: Non-Preferred Drug	0%	0%	0%	0%	0%	0%
Tier 5: Specialty Tier	0%	0%	0%	0%	0%	0%