{"id":629921,"date":"2024-09-30T17:29:13","date_gmt":"2024-09-30T21:29:13","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=629921"},"modified":"2026-01-02T16:14:16","modified_gmt":"2026-01-02T21:14:16","slug":"does-medicaid-cover-humira","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicaid-cover-humira\/","title":{"rendered":"Does Medicaid cover Humira?"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-humira\/\"><span style=\"font-weight: 400;\">Humira (adalimumab)<\/span><\/a><span style=\"font-weight: 400;\"> is a brand-name prescription medication commonly used to treat autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, Crohn&#8217;s disease, and ulcerative colitis. It contains adalimumab, a tumor necrosis factor (TNF) blocker. It works by blocking TNF, a substance in the body that triggers inflammation in autoimmune diseases. <\/span><a href=\"https:\/\/www.rxabbvie.com\/pdf\/humira_medguide.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Humira<\/span><\/a><span style=\"font-weight: 400;\"> is a self-injection given under the skin, similar to insulin shots. It comes in a prefilled syringe or an automatic \u201cpen\u201d injector.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The cost of Humira can vary depending on your insurance, the reason you need it, and the pharmacy you use. And if you have Medicaid, it may entirely or partially cover the cost of Humira.<\/span><\/p>\n<h2 id=\"how-much-does-humira-cost\"><span style=\"font-weight: 400;\">How much does Humira cost?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Humira costs<\/span> <a href=\"https:\/\/www.singlecare.com\/blog\/humira-cost\/\"><span style=\"font-weight: 400;\">an average of $8,900<\/span><\/a><span style=\"font-weight: 400;\"> for a box of two pen injectors, which is a one-month supply. However, most people don\u2019t pay this price, as this is the cost without insurance and discounts. There are various factors that determine how much you\u2019ll pay for Humira, including your choice of pharmacy and the dosage prescribed to you. For example, a higher dosage or a more frequent dosing schedule will increase the overall cost.<\/span><\/p>\n<h2 id=\"does-medicaid-cover-humira\"><span style=\"font-weight: 400;\">Does Medicaid cover Humira?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicaid coverage for Humira varies significantly from state to state. While some states may cover the medication for all approved uses, others might have stricter guidelines or require additional documentation to justify medical necessity.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It&#8217;s essential to check with your healthcare provider and <\/span><a href=\"https:\/\/www.medicaid.gov\/state-overviews\/index.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">state Medicaid office<\/span><\/a><span style=\"font-weight: 400;\"> to determine whether it covers Humira. They can provide specific information on coverage to give you an idea of how much you can expect to pay out of pocket.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here are a few examples:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>California Medicaid (Medi-Cal)<\/b><span style=\"font-weight: 400;\">: This could require prior authorization and proof that other medications were tried first (step therapy).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>New York Medicaid<\/b><span style=\"font-weight: 400;\">: Coverage may be available but with specific requirements based on medical necessity.<\/span><\/li>\n<\/ul>\n<h2 id=\"factors-influencing-medicaid-coverage-for-humira\"><span style=\"font-weight: 400;\">Factors influencing Medicaid coverage for Humira<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If Medicaid covers Humira in your state, several factors could influence your eligibility for coverage. These factors might include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Your diagnosis:<\/b><span style=\"font-weight: 400;\"> You may need a specific diagnosis, such as rheumatoid arthritis or Crohn&#8217;s disease, that aligns with the state&#8217;s coverage criteria.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Your treatment history:<\/b><span style=\"font-weight: 400;\"> Before Medicaid covers Humira, you may be required to show that other, less expensive treatments are ineffective. This is often referred to as<\/span> <a href=\"https:\/\/www.singlecare.com\/blog\/step-therapy\/\"><span style=\"font-weight: 400;\">step therapy<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><b>Prior authorization<\/b><\/a><b>:<\/b><span style=\"font-weight: 400;\"> Your state Medicaid agency may require your healthcare provider to submit documentation proving that Humira is medically necessary for your condition.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">These criteria can vary widely from state to state, so it&#8217;s important to consult your healthcare provider and your state&#8217;s Medicaid office to understand what to expect when using Medicaid to pay for Humira.<\/span><\/p>\n<h2 id=\"how-to-get-humira-with-medicaid\"><span style=\"font-weight: 400;\">How to get Humira with Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you are eligible for Medicaid coverage for Humira, follow these steps to obtain the medication:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Discuss your condition with your healthcare provider to determine if Humira is the right treatment option. If they believe it is your best option, they\u2019ll write you a prescription.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Your healthcare provider must submit a prior authorization request to Medicaid, which requires providing your medical history and an explanation of why you need Humira. This could be time-consuming, so be sure to discuss interim treatment options to help manage your symptoms until you can get your prescription filled.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Once the prior authorization is approved, take your prescription to a pharmacy that accepts Medicaid. If there are any issues, your pharmacist may contact your healthcare provider or Medicaid office.<\/span><\/li>\n<\/ol>\n<h2 id=\"cost-of-humira-with-medicaid\"><span style=\"font-weight: 400;\">Cost of Humira with Medicaid<\/span><\/h2>\n<p><a href=\"https:\/\/www.humira.com\/cost\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">AbbVie Inc.<\/span><\/a><span style=\"font-weight: 400;\">, the manufacturer of Humira, says most people with Medicaid coverage for Humira pay less than $10.40 each month, although coverage varies by state. Medicaid can reduce the cost significantly, but you may still need to cover some <\/span><a href=\"https:\/\/www.cms.gov\/marketplace\/technical-assistance-resources\/medicaid-chip-overview.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">out-of-pocket expenses<\/span><\/a><span style=\"font-weight: 400;\">, such as:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Copayments: <\/b><span style=\"font-weight: 400;\">Some states may require you to pay a small fee, typically between $0 and $10, each time you fill your Humira prescription.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Coinsurance:<\/b><span style=\"font-weight: 400;\"> Depending on your state of residence, you might need to pay a percentage of the medication&#8217;s cost.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Monthly premiums:<\/b><span style=\"font-weight: 400;\"> If you must pay a premium for your Medicaid coverage, this could also factor into your overall cost.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Deductible:<\/b><span style=\"font-weight: 400;\"> Your plan may require you to pay a certain amount before coverage begins.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">To better understand what you might pay, check your state&#8217;s Medicaid preferred drug list or contact your Medicaid office.<\/span><\/p>\n<h2 id=\"how-to-afford-humira-without-medicaid\"><span style=\"font-weight: 400;\">How to afford Humira without Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you do not have Medicaid or your state does not cover Humira, there are <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/humira-cost\/\"><span style=\"font-weight: 400;\">several ways to reduce the cost<\/span><\/a><span style=\"font-weight: 400;\">, including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Using a <\/b><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><b>SingleCare prescription discount card<\/b><\/a><span style=\"font-weight: 400;\">: SingleCare provides instant access to coupons you can use at pharmacies around the country. With a <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/humira\"><span style=\"font-weight: 400;\">SingleCare coupon for Humira<\/span><\/a><span style=\"font-weight: 400;\">, you could pay $6,042 instead of the average retail price, which is $8,900 at the time of publication.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Considering <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/humira-alternatives\/\"><b>Humira alternatives<\/b><\/a><b>:<\/b><span style=\"font-weight: 400;\"> Humira is not available as a generic drug because it is a biologic medication made from living cells. However, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/humira-generic\/\"><span style=\"font-weight: 400;\">biosimilar versions are available<\/span><\/a><span style=\"font-weight: 400;\">. These biosimilar alternatives are approved by the Food and Drug Administration and offer a lower-cost option while maintaining the same safety and effectiveness.<\/span><\/li>\n<\/ul>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/humira-patient-assistance\/\"><b>Humira patient assistance<\/b><\/a><\/p>\n<p><span style=\"font-weight: 400;\">To understand how much you need to pay for Humira with Medicaid, it\u2019s essential to know how your state Medicaid agency covers it. Without coverage, there are ways to get discounts and programs that can make Humira more affordable. Remember that, if you have both Medicare and Medicaid, you are considered dually eligible, meaning<\/span> <span style=\"font-weight: 400;\">you can <\/span><a href=\"https:\/\/www.medicare.gov\/basics\/costs\/help\/medicaid\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">use Medicaid to pay for certain things that Medicare won&#8217;t<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><small><em><span style=\"font-weight: 400;\">The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of Jan. 2, 2026. Prices vary by pharmacy. Visit our <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/humira\"><span style=\"font-weight: 400;\">Humira coupon page<\/span><\/a><span style=\"font-weight: 400;\"> for updated Humira prices near you.<\/span><\/em><small><\/small><\/small><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Humira (adalimumab) is a brand-name prescription medication commonly used to treat autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, Crohn&#8217;s disease, and ulcerative colitis. It contains adalimumab, a tumor necrosis factor (TNF) blocker. It works by blocking TNF, a substance in the body that triggers inflammation in autoimmune diseases. Humira is a self-injection given under [&hellip;]<\/p>\n","protected":false},"author":149,"featured_media":629922,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[4343,16],"coauthors":[21032],"class_list":["post-629921","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-brand-name-drugs","tag-medicaid","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Does Medicaid cover Humira?<\/title>\n<meta name=\"description\" content=\"Medicaid covers Humira, and most Medicaid beneficiaries pay $10 or less per month, although coverage varies by state.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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