{"id":630176,"date":"2024-10-22T13:56:59","date_gmt":"2024-10-22T17:56:59","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630176"},"modified":"2026-04-10T15:24:26","modified_gmt":"2026-04-10T19:24:26","slug":"does-aetna-cover-humira","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-aetna-cover-humira\/","title":{"rendered":"Does Aetna cover Humira?"},"content":{"rendered":"

If you are living with an autoimmune condition, your healthcare provider may prescribe <\/span>Humira<\/span><\/a> (adalimumab). Humira is approved by the Food and Drug Administration (FDA) to treat conditions such as <\/span>rheumatoid arthritis<\/span><\/a>, <\/span>Crohn\u2019s disease<\/span><\/a>, ulcerative colitis, psoriatic arthritis, ankylosing spondylitis, uveitis, and juvenile idiopathic arthritis (JIA). As a complex biologic drug, it is very expensive to make, and that cost is passed down to consumers. There are several <\/span>biosimilar versions<\/span><\/a> available, which may be more affordable options than brand-name versions. If you have insurance through Aetna, your plan may not cover brand-name Humira, but may be more likely to cover a biosimilar.\u00a0\u00a0<\/span><\/p>\n

Does Aetna cover Humira?<\/span><\/h2>\n

\u200b\u200bAs of April 1, 2024, most Aetna formularies <\/span>no longer cover brand-name Humira<\/span><\/a>. With these changes, though, members will typically have access to a selection of biosimilar adalimumab products that are lower-cost alternatives, such as Cyltezo (adalimumab-adbm), Yusimry (adalimumab-aqvh), and Hulio (adalimumab-fkjp). Some healthcare providers may recommend completely different alternatives, depending on the condition being treated.\u00a0<\/span><\/p>\n

\u201cMethotrexate is our first-line treatment for rheumatoid arthritis,\u201d says <\/span>Francesca Okoye<\/span><\/a>, MD, a board-certified rheumatologist with Rheumatology at Mercy Medical Center in Baltimore, Maryland. \u201cI prescribe Humira for patients who have failed to improve on methotrexate or who have not tolerated it. Or I would prescribe Humira for people who have other medical conditions and who cannot take methotrexate.\u201d<\/span><\/p>\n

Insurance coverage can be complicated, and every health plan is different. The best way to confirm whether your Humira will be covered or not is to check your insurance plan\u2019s formulary, which is a list of drugs that an insurance company covers.<\/span><\/p>\n

In many instances, <\/span>prior authorization<\/span><\/a> may be required for certain medications. This is when a healthcare provider coordinates with the insurance company to ensure that a prescribed medicine or treatment is medically necessary.<\/span><\/p>\n

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

Humira costs<\/span><\/a> vary by pharmacy, but without insurance or discounts, you can expect to pay the average retail price of $8,887 for a one-month supply of two brand-name Humira subcutaneous autoinjectors. This drug\u2019s high cost is due to its complex production process and use of DNA technology. Note that prices vary depending on the dosage, quantity, and pharmacy.\u00a0<\/span><\/p>\n

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

If you have an Aetna insurance plan, what you pay out of pocket for your prescription will depend on the specifics of your plan. Since Humira is a specialty drug, it is likely to be on the highest drug tier, meaning the most expensive copay. Different Aetna plans may charge different amounts for Humira (or a biosimilar). For example, if you have an Aetna Medicare Part D plan, you may pay $0\u2013$2,100 per month, depending on which coverage phase you\u2019re in, <\/span>according to its manufacturer, AbbVie<\/span><\/a>.\u00a0\u00a0<\/span><\/p>\n

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

There are a number of ways to find out if your Humira will be covered by Aetna:<\/span><\/p>\n