Humana is one of the largest Medicare Advantage and Part D providers in the United States, covering millions of seniors. Humana's 2026 formulary reflects recent Inflation Reduction Act changes, including the $2,000 annual out-of-pocket cap for Part D plans. Commercial plan formularies are managed separately and vary by employer.

Key Facts

Humana's Medicare Part D plans feature a $2,000 annual out-of-pocket maximum in 2026 (per IRA provisions)
The formulary uses 5 tiers for Medicare plans: Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, and Specialty
Humana Pharmacy (mail order) and CenterWell Pharmacy offer preferred pricing
Humana covers all Part D required drug categories and classes
Prior authorization decisions for urgent requests are made within 24 hours
Humana's Value plan formulary is more restrictive but has lower monthly premiums

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ACA marketplace enrollment runs November 1 to January 15. Medicare Annual Enrollment is October 15 to December 7. Compare formularies for your medications before choosing a plan.

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Coverage varies by plan. Use our formulary checker tool to look up your exact copay and restrictions.

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Frequently Asked Questions

How does the $2,000 out-of-pocket cap work for Humana Medicare Part D?

Starting in 2025 (continuing in 2026), Medicare Part D plans including Humana cap your annual out-of-pocket drug spending at $2,000. Once you reach this amount, you pay $0 for the rest of the year. Humana also offers the Medicare Prescription Payment Plan, which lets you spread costs across monthly installments.

Does Humana cover insulin?

Yes. Under Medicare Part D regulations, Humana caps insulin copays at $35 per month for a 30-day supply of covered insulin products. This applies to both vials and pens. Many Humana commercial plans also offer similar insulin cost caps.

Can I switch Humana plans if my drug is not covered?

You can switch Humana Medicare plans during the Annual Enrollment Period (October 15 to December 7) or during the Medicare Advantage Open Enrollment Period (January 1 to March 31). For employer plans, you would need to wait for your employer's open enrollment period.

Related Resources

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