Humira is a prescription medication that reduces the signs and symptoms of arthritis, Crohn’s disease, and ankylosing spondylitis. It’s a tumor necrosis factor (TNF) blocker drug and is one of the best-selling medications in the world. Let’s take a look at how much Humira costs, whether or not insurance covers it, and how to save money on it.
How much does Humira cost?
Humira (adalimumab) is a very expensive drug that costs about $7,389 for two subcutaneous kits (10 mg/0.1 mL). Two subcutaneous kits typically contain a month’s supply of Humira, which means it can cost upward of $84,000 to take the medication for a whole year.
It’s possible to pay less for Humira if you have a discount card or insurance plan that covers it, but Humira is an expensive drug regardless of whether or not you’re able to find a discounted price. One of the reasons that Humira is so expensive is because it’s a complex medication to make. DNA technology must be used to create proteins for the drug—a process that can’t be replicated, unlike with synthetically manufactured medications. Humira works by blocking and reducing the effects of tumor necrosis factor (TNF), which causes inflammation. People with autoimmune diseases like arthritis or Crohn’s disease produce too much TNF, which is why they’re often prescribed Humira.
Humira is a biologic, which is just another way of saying that it’s composed of DNA. Because of this, the FDA requires that it undergo extensive research and testing—another reason why it’s so expensive. There is no way for manufacturers to bypass FDA requirements; although, that would theoretically make Humira cheaper for those who need it.
Does insurance cover Humira?
Sometimes insurance plans will help cover the cost of Humira, which makes it easier for those who need the medication. Humira is covered by most insurance plans, but individual plans may vary in how much they cover. Insurance may be able to lower the out-of-pocket price of Humira from about $7,389 to approximately $5,000 per month.
Some people who receive employer/retiree commercial prescription coverage will be eligible for a Humira Complete Savings Card. The Humira Complete Savings card is only available to people who have private insurance coverage from their employer or to people who have purchased insurance coverage directly from insurance companies. Copay assistance is not available for people who receive prescription reimbursement through federal, state, or government-funded insurance programs.
Does Medicare cover Humira?
People without private insurance coverage may be able to get Humira at a reduced cost through Medicare or Medicaid. Medicare is a federal health insurance program for adults older than 65 and for individuals with certain disabilities. Prescription coverage is available through Medicare Advantage Plans (Part C) and Supplemental Plans (Part D).
Medicare Advantage Plans provide Medicare Part A and B coverage (hospital and medical insurance), and can sometimes include prescription coverage. Medicare Part D can be added to Medicare Parts A and B for additional prescription coverage.
Most Medicare plans list Humira as a tier 5 drug because it’s a specialty medication, and tier 5 drugs typically cost more than tier 1-4 drugs. Because Medicare lists Humira as a tier 5 drug, most people will need Medicare Part D in addition to Medicare Part C, but it’s possible for some Part C Plans to cover Humira on their own.
Some people with Medicare coverage will be eligible for the Extra Help subsidy, which can lower the cost of Humira as well. Eligibility for this subsidy is determined by Medicare, and the subsidy can’t be combined with the Humira Complete Savings Card. You can visit medicare.gov or call the number on your Medicare insurance card to see if you qualify for the Extra Help subsidy.
Does Medicaid cover Humira?
Medicaid works a little bit differently than Medicare. It’s run by the federal government and individual states, and provides medical assistance for low-income individuals and families. Even though pharmacy coverage is an optional benefit under federal Medicaid Law, some state Medicaid programs may cover the cost of Humira, but coverage will vary from state to state. Visit medicaid.gov to learn more about whether or not Humira would be covered for you based on where you live.
The best way to see if your insurance covers Humira is to check your individual insurance plan. Your insurance company’s website may give you the information you need, or you may have to call your insurance provider directly. Humira’s website, humira.com, also has some great resources, and they even have insurance specialists you can call who will help you determine if your insurance will cover Humira.
4 ways to save on Humira
Getting the best price on Humira may require doing a little research to make sure you’re saving as much as you can. Here are five of the best ways to get Humira at a cheaper price.
Using the benefits of your health insurance plan to your advantage is one of the best ways to save money on Humira. As mentioned earlier, some insurance plans will cover the cost of Humira, or reduce your out-of-pocket cost. People with private insurance coverage may be eligible for a Humira Complete Savings Card. Medicare and Medicaid may also reduce the cost of Humira depending on the individual plan you have and/or where you live. It’s not possible, however, to be on Medicare, Medicaid, Medigap, TRICARE, Medicare Advantage, or Veterans Affairs programs and get the Humira Complete Savings Card.
It’s important to note that most insurance plans will require you to complete a prior authorization form or step therapy process before they will agree to cover the cost of Humira. A prior authorization form is an approval of coverage from your insurance company that is used to help ensure the drug you’re purchasing is the most appropriate and cost-effective medication being used. The step therapy process requires that other drugs are tried for a certain amount of time before moving on to Humira. This ensures that potentially cheaper drugs are tried first for treating your specific medical condition. Restrictions can make it difficult to get insurance coverage for Humira, but you can always ask your doctor for an appeal if your insurance doesn’t cover Humira.
2. Humira coupons
Using coupons can be a great way to pay less for Humira. AbbVie Inc., the manufacturer of Humira, offers the Humira Complete Savings Card but not everyone is eligible for this savings card. For those who aren’t eligible, using an online coupon is a great second-option. If you use a SingleCare coupon for Humira, you could pay $5,273 instead of $7,389 for each pre-filled syringe kit box. Online coupons like this can be used at participating pharmacies like Walgreens, Rite Aid, Walmart, CVS, and others.
3. Manufacturer rebates
Sometimes a pharmacy won’t accept the Humira Complete Savings Card, which could leave you with a hefty bill. You may still be able to lower Humira costs by using the Humira Complete Prescription Rebate. Rebates are only available for people with commercial prescription coverage or self-insured patients. If you meet these requirements though, you may be able to collect your receipts from Humira and receive a rebate check from Opus Health. If you want to learn more about saving money on Humira through rebates, visit the manufacturer’s website.
4. AbbVie Patient Assistance Program
Unemployed or underinsured patients may qualify for the AbbVie Patient Assistance Program. This program provides no-cost assistance to those who meet certain income criteria. It’s free to apply to the program, and those who qualify receive their medication completely free of cost. Visit AbbVie’s website to see if you qualify to get Humira for free.
Is there a generic version of Humira?
Oftentimes there will be generic versions of brand-name medications that are more affordable for consumers. Unfortunately, there is no generic version of Humira or biosimilar drug on the market in the United States that people can purchase at a lower cost.
Ever since 2002, AbbVie has carefully constructed patents to make sure that Humira is protected from biosimilar competition. In 2016, the manufacturer Amgen made a drug called Amjevita, which became the first biosimilar to Humira to get approval from the Food and Drug Administration (FDA). Amgen was granted the right to launch its biosimilar in Europe in 2018 and will release it in the United States in 2023. The following list of Humira biosimilars will be available in the U.S. in 2023:
- Abrilada by Pfizer
- Amjevita by Amgen
- CHS-1420 by Coherus BioSciences
- Cyltezo by Boehringer Ingelheim
- Hadlima by Merck/Samsung Bioepis
- Hulio by Mylan
- Hyrimoz by Novartis/Sandoz
- MSB11022 by Fresenius Kabi
Until the release of biosimilars made by other pharmaceutical companies, U.S. citizens will continue to have to purchase Humira at full cost if it’s not covered by their insurance or if they’re unable to get it at a cheaper price.
There are other prescription drugs on the market that can treat rheumatoid arthritis, Crohn’s disease, hidradenitis suppurativa, and other conditions that Humira treats. Because these other drugs are biologic drugs though, they’ll be similar in price to Humira. If the side effects of Humira become too much for someone, they may have to look into taking a different medication. Here are the most common side effects of Humira to be aware of:
- Injection site reactions
- Urinary tract infections
- Upper respiratory tract infections
- Back pain
Those interested in alternatives to Humira can talk to their doctor about the following options.
|Uses||Average retail price||SingleCare savings||Additional information|
Note: Enbrel can’t treat Crohn’s disease and ulcerative colitis like Humira can.
|$6,100 per 4, 50 mg/ml injectable solution||Get coupon||Learn more|
||$11,502 for a supply of 10, 100 mg vials||Get coupon||Learn more|
||More than $7,000 per monthly injection||Get coupon||Learn more|
“The appropriate biologic to prescribe depends on the patient’s unique situation and other factors such as medical history, duration of the condition, severity of the condition, past medical treatments, and treatment goals,” says Anna H. Chacon, MD, a U.S. board-certified dermatologist based in South Florida.
This is why it’s so important to talk with your doctor about whether or not Humira is right for you. Your doctor will be able to give you medical advice that’s specific to you, and may also be able to help you find a way to save on your Humira prescription.