{"id":630059,"date":"2024-10-09T14:04:45","date_gmt":"2024-10-09T18:04:45","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630059"},"modified":"2026-04-09T16:03:15","modified_gmt":"2026-04-09T20:03:15","slug":"does-blue-cross-cover-humira","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-blue-cross-cover-humira\/","title":{"rendered":"Does Blue Cross cover Humira?"},"content":{"rendered":"

Humira<\/span> (adalimumab) is a TNF blocker, an immunosuppressant drug that can treat the symptoms of rheumatoid arthritis, Crohn\u2019s disease, and psoriatic arthritis, along with certain other inflammatory diseases like ankylosing spondylitis and plaque psoriasis. However, its effectiveness and versatility come at a cost, which leaves many people looking to their insurance provider for help. Many health insurance and Medicare Part D plans will cover Humira, including some from Blue Cross Blue Shield, but it depends on the specific plan. Here\u2019s what you need to know.<\/span><\/p>\n

Does Blue Cross Blue Shield cover Humira?<\/span><\/h2>\n

Yes, some Blue Cross Blue Shield (BCBS) plans cover Humira, but that doesn\u2019t mean everyone will get coverage. BCBS has a range of plans, and they all have different prescription drug benefits.<\/span><\/p>\n

The Blue Cross and Blue Shield Association isn\u2019t a single company either. Rather, it\u2019s various independent and locally operated companies and licensees. If you live in New York, your BCBS plan\u2019s policies could vary significantly from those of a BCBS beneficiary living in Florida, Texas, or anywhere else.<\/span><\/p>\n

Many of these plans will cover Humira if it\u2019s essential for your condition, but there may be some caveats. \u201cSince it’s considered a specialty drug, you may need prior authorization or have to go through step therapy before getting approval,\u201d says<\/span> Andrew Youssouf, MD<\/span><\/a>,<\/span> medical director of<\/span> Ikon Recovery<\/span><\/a>. Prior authorization is the process by which insurance companies <\/span>confirm a drug is medically necessary<\/span><\/a>, typically involving some extra paperwork on your healthcare provider\u2019s end. <\/span>Step therapy<\/span><\/a> means trying other, less expensive drugs before you can qualify for coverage. As a <\/span>specialty medication<\/span><\/a>, Humira requires specific handling, administration, and monitoring, so you have to get it from a specialty pharmacy or other designated location.<\/span><\/p>\n

If you have a Medicare Part D or Medicare Advantage plan, it works pretty much the same way. For people who receive their Humira injections in their healthcare provider\u2019s office, however, <\/span>it might fall under Medicare Part B instead<\/span><\/a>.<\/span><\/p>\n

RELATED: <\/b>Does Medicaid cover Humira?<\/b><\/a><\/p>\n

What about Humira biosimilars?<\/span><\/h3>\n

Humira is a biologic drug, which means it\u2019s created from living cells rather than synthetic chemicals. This is an expensive and time-consuming process, which is why biologics often cost more than other drugs. Fortunately, the Food and Drug Administration (FDA) has approved <\/span>several Humira biosimilars<\/span><\/a>, including Amjevita, Cyltezo, Hadlima, and Yuflyma.<\/span><\/p>\n

Biosimilar drugs<\/span><\/a> are highly similar to their brand-name biologic counterparts, and the FDA says that they\u2019re \u201cjust as safe and effective as their reference products.\u201d Like generic drugs, they\u2019re also often less expensive. However, many of them are pretty new, and some BCBS plans don\u2019t cover them as consistently as Humira. Still, it may be worth checking their prices.<\/span><\/p>\n

RELATED: <\/b>Humira generic availability, cost, and dosage<\/b><\/a><\/p>\n

How much does Humira cost?<\/span><\/h2>\n

For many people, insurance coverage is important, since <\/span>Humira\u2019s average out-of-pocket cost<\/span><\/a> without it is around $8,844 for two autoinjectors, which is typically a one-month supply. At that price, an annual supply would cost more than $100,000. Fortunately, many people either find insurance coverage or take advantage of other ways to save on Humira, which we\u2019ll cover later.<\/span><\/p>\n

Even when it\u2019s included in your medical benefits, health insurance plans have cost-sharing policies where the beneficiary must pay certain portions of the cost. The most common way they do this is through copays. Many plans organize drugs into tiers, covering more for lower tiers than higher ones. \u201cEach plan is different, but Humira is usually on the higher end of the drug list,\u201d Dr. Youssouf says. \u201cWhich means you might have to pay more in copays or coinsurance,\u201d he adds.<\/span><\/p>\n

Data from KFF<\/span><\/a> shows that the average copayment is $11 for tier 1 drugs, $36 for tier 2 drugs, $66 for tier 3 drugs, and $125 for tier 4 drugs. But Humira can sometimes have a much higher copay because of its high price and specialty classification.<\/span><\/p>\n

As mentioned above, biologics like Humira may have less expensive biosimilars. For example, the Humira biosimilar <\/span>Hyrimoz<\/span><\/a> has an average retail price of $2,124 for a one-month supply. Another biosimilar, <\/span>Hadlima<\/span><\/a>, costs about $1,391 before insurance or discounts. These biosimilars are highly similar to Humira and may be more affordable.\u00a0\u00a0<\/span><\/p>\n

How much does Humira cost with Blue Cross Blue Shield?<\/span><\/h3>\n

It could be $0, or it could be a lot more. Once again, it depends on your plan. Beyond copays, BCBS and other insurance companies have a few other ways to dictate the beneficiary\u2019s out-of-pocket costs. One is your deductible, which is the total amount you need to pay before coverage kicks in. After you hit your deductible, the insurance provider may cover all of your prescription drug costs, or they may only cover a certain percentage (coinsurance). A drug\u2019s tier usually dictates the plan\u2019s copay and coinsurance amounts.<\/span><\/p>\n

How to check whether your BCBS plan covers Humira\u00a0<\/span><\/h2>\n

Whether it\u2019s copays, coinsurance, deductibles, or drug tiers, the hub for all this prescription drug coverage information is your plan\u2019s formulary. This is a drug list that shows each medication\u2019s tier and other requirements, like prior authorization.<\/span><\/p>\n

The independent licensees of Blue Cross usually house drug lists for each of their plans online. One fairly easy way to find them is to search for \u201cBlue Cross Blue Shield drug lists\u201d plus the name of your state. Once you\u2019re viewing the formulary, scroll down until you find Humira. It should list its tier and whether there are any prior authorization requirements or other restrictions. \u201cIt’s also a good idea to review your Summary of Benefits and Coverage document to fully grasp the expenses,\u201d Dr. Youssouf says. \u201cDepending on your plan, using a specialty pharmacy may be required and could potentially have lower costs through certain networks.\u201d<\/span><\/p>\n

You also have the option of calling your state\u2019s Blue Cross Blue Shield company directly and speaking with a representative. They\u2019ll likely ask for your group number and member ID, so have your insurance card ready.<\/span><\/p>\n

What to do if insurance won\u2019t cover Humira<\/span><\/h2>\n

If your BCBS plan initially denies your prescription for Humira, check with your healthcare provider about a prior authorization. Drugs like Humira typically require pre-approval from your insurance. This means that your healthcare provider\u2019s office must submit additional clinical information to your plan about why the drug is medically necessary for you.\u00a0<\/span><\/p>\n

If your plan denies the prior authorization request, your healthcare provider can appeal the decision by submitting additional supporting information. If the appeal is also denied, you can look into prescription discount programs, like SingleCare, as well as savings options from Humira\u2019s manufacturer, AbbVie. You can also ask your provider about a Humira biosimilar that may be much more affordable and just as effective, or look into other <\/span>Humira alternatives<\/span><\/a>.\u00a0<\/span><\/p>\n

How to get Humira without insurance<\/span><\/h2>\n

Insurance can significantly decrease your prescription medication costs, but it\u2019s not the only way to do so. If you are paying without insurance, there are other options to explore. <\/span>Patient assistance programs<\/span><\/a> from the manufacturer, government assistance programs, and asking a healthcare provider about biosimilar options are all ways to <\/span>save money on Humira<\/span><\/a>.<\/span><\/p>\n

Plus, <\/span>Humira coupons from SingleCare<\/span><\/a> can help take thousands of dollars off the average price. SingleCare works directly with partnering pharmacies and pharmacists to secure discounts on thousands of drugs, and anyone can sign up to get them.\u00a0<\/span><\/p>\n

RELATED: <\/b>Humira alternatives<\/b><\/a><\/p>\n

The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of March 25, 2026. Prices vary by pharmacy. Visit our <\/span><\/i>Humira coupon page<\/span><\/i><\/a> for updated Humira prices near you.<\/span><\/i>\u00a0<\/span><\/small><\/small><\/p>\n","protected":false},"excerpt":{"rendered":"

Humira (adalimumab) is a TNF blocker, an immunosuppressant drug that can treat the symptoms of rheumatoid arthritis, Crohn\u2019s disease, and psoriatic arthritis, along with certain other inflammatory diseases like ankylosing spondylitis and plaque psoriasis. However, its effectiveness and versatility come at a cost, which leaves many people looking to their insurance provider for help. Many […]<\/p>\n","protected":false},"author":15,"featured_media":630060,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[4343,608],"coauthors":[8861],"class_list":["post-630059","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-brand-name-drugs","tag-health-insurance","wpautop"],"acf":[],"yoast_head":"\nDoes Blue Cross cover Humira?<\/title>\n<meta name=\"description\" content=\"Blue Cross often covers Humira, but only for approved conditions, and coverage varies by plan. 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