Humana Premier Rx Plan (PDP)

Humana Premier Rx Plan (PDP) S5884-169 Plan Details

3 out of 5 stars

Humana Premier Rx Plan (PDP) is a plan offered by Humana Inc..
Plan ID: S5884-169.

^$72.90

Monthly Premium

Humana Premier Rx Plan (PDP) is a plan offered by Humana Inc..
Plan ID: S5884-169.

Humana Premier Rx Plan (PDP) S5884-169 Plan Details

3 out of 5 stars

Humana Premier Rx Plan (PDP) is a plan offered by Humana Inc..
Plan ID: S5884-169.

^$72.90

Monthly Premium

Oklahoma Counties Served

Adair Atoka Canadian Carter Le Flore Alfalfa Beaver Beckham Blaine Bryan Caddo Cherokee Choctaw Cimarron Cleveland Coal Comanche Cotton Craig Creek Custer Delaware Dewey Ellis Garfield Garvin Grady Grant Greer Harmon Harper Haskell Hughes Jackson Jefferson Johnston Kay Kingfisher Kiowa Latimer Lincoln Logan Love Major Marshall Mayes Mcclain Mccurtain Mcintosh Murray Muskogee Noble Nowata Okfuskee Oklahoma Okmulgee Osage Ottawa Pawnee Payne Pittsburg Pontotoc Pottawatomie Pushmataha Roger Mills Sebastian Seminole Sequoyah Stephens Texas Tillman Tulsa Wagoner Washington Washita Woods Woodward

Basic Costs and Coverage

Coverage	Cost
Monthly Deductible	$300
Out of Pocket Max	In-Network: $-1 Out-of-Network: N/A
Initial Coverage Limit	$4660
Catastrophic Coverage Limit	$7,400

Prescription Drug Costs and Coverage

The Humana Premier Rx Plan (PDP) plan offers the following prescription drug coverage, with an annual drug deductible of $300 (excludes Tiers 1 and 2) per year.

Coverage	Cost
Coverage & Cost
Annual Drug Deductible	$300 (excludes Tiers 1 and 2)
Preferred Generic	Preferred cost-share retail $1.00 Standard retail $5.00 Preferred cost-share mail order $1.00 Standard mail order $5.00
Generic	Preferred cost-share retail $4.00 Standard retail $10.00 Preferred cost-share mail order $4.00 Standard mail order $10.00
Annual Drug Deductible	$300 (excludes Tiers 1 and 2)
Preferred Generic	Preferred cost-share retail N/A Standard retail N/A Preferred cost-share mail order N/A Standard mail order N/A
Generic	Preferred cost-share retail N/A Standard retail N/A Preferred cost-share mail order N/A Standard mail order N/A
Annual Drug Deductible	$300 (excludes Tiers 1 and 2)
Preferred Generic	Preferred cost-share retail $3.00 Standard retail $15.00 Preferred cost-share mail order $0.00 Standard mail order $15.00
Generic	Preferred cost-share retail $12.00 Standard retail $30.00 Preferred cost-share mail order $0.00 Standard mail order $30.00

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Humana Premier Rx Plan (PDP)

Oklahoma Counties Served

Basic Costs and Coverage

Prescription Drug Costs and Coverage

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