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Is Humira Covered by Insurance? A Comprehensive Guide

What is Humira?

Humira, also known as adalimumab, is a biologic medication used to treat various autoimmune diseases, including rheumatoid arthritis, psoriatic arthritis, Crohn's disease, ulcerative colitis, and plaque psoriasis. It is a tumor necrosis factor (TNF) blocker, which works by blocking the action of TNF, a protein that contributes to inflammation and joint damage.

Is Humira Covered by Insurance?

Humira is a prescription medication, and as such, its coverage by insurance varies depending on the specific insurance plan and provider. However, Humira is one of the most widely prescribed biologics in the world, and many insurance plans cover it.

How to Check Humira Coverage?

To determine if Humira is covered by your insurance, you can:

1. Check your insurance plan's formulary: Your insurance plan's formulary is a list of approved medications. You can check your plan's website or contact your insurance provider to see if Humira is listed.
2. Contact your insurance provider: Reach out to your insurance provider's customer service department and ask about Humira coverage. They can provide you with more information on the medication's coverage and any requirements for obtaining it.
3. Check with your doctor: Your doctor may be able to provide guidance on Humira coverage and help you navigate the process.

Humira Coverage by Insurance Type

Medicare: Humira is covered by Medicare Part D, but the coverage may vary depending on the specific plan and provider.

Medicaid: Medicaid coverage for Humira varies by state. Some states cover Humira, while others may not.

Private Insurance: Many private insurance plans cover Humira, but the coverage may vary depending on the specific plan and provider.

Cost of Humira Without Insurance

If you do not have insurance or your insurance plan does not cover Humira, the cost of the medication can be significant. According to DrugPatentWatch.com, the average wholesale price (AWP) of Humira is around $2,000 per 40mg injection.

Tips for Getting Humira Coverage

1. Check with your insurance provider: As mentioned earlier, contact your insurance provider to see if Humira is covered and what the requirements are for obtaining it.
2. Consider a specialty pharmacy: Some insurance plans require patients to use a specialty pharmacy to obtain Humira. This can help streamline the process and ensure that you receive the medication.
3. Look into patient assistance programs: Some pharmaceutical companies offer patient assistance programs (PAPs) that can help patients obtain medications, including Humira, at a reduced cost or for free.
4. Consider a copay card: Some insurance plans offer copay cards that can help reduce the out-of-pocket cost of Humira.

Conclusion

Humira is a widely prescribed biologic medication used to treat various autoimmune diseases. While insurance coverage for Humira varies depending on the specific plan and provider, many insurance plans cover it. If you do not have insurance or your insurance plan does not cover Humira, the cost of the medication can be significant. However, there are steps you can take to get Humira coverage, including checking with your insurance provider, considering a specialty pharmacy, looking into patient assistance programs, and considering a copay card.

Key Takeaways

* Humira is a biologic medication used to treat various autoimmune diseases.
* Insurance coverage for Humira varies depending on the specific plan and provider.
* Many insurance plans cover Humira, but the coverage may vary.
* The cost of Humira without insurance can be significant.
* There are steps you can take to get Humira coverage, including checking with your insurance provider, considering a specialty pharmacy, looking into patient assistance programs, and considering a copay card.

FAQs

1. Is Humira covered by Medicare?

Humira is covered by Medicare Part D, but the coverage may vary depending on the specific plan and provider.

2. Is Humira covered by Medicaid?

Humira coverage by Medicaid varies by state. Some states cover Humira, while others may not.

3. How much does Humira cost without insurance?

According to DrugPatentWatch.com, the average wholesale price (AWP) of Humira is around $2,000 per 40mg injection.

4. How can I get Humira coverage?

You can check with your insurance provider, consider a specialty pharmacy, look into patient assistance programs, and consider a copay card to get Humira coverage.

5. Is Humira a biologic medication?

Yes, Humira is a biologic medication used to treat various autoimmune diseases.

Sources

1. DrugPatentWatch.com. (n.d.). Adalimumab (Humira). Retrieved from <https://www.drugpatentwatch.com/drug/adalimumab-humira>
2. National Institute of Arthritis and Musculoskeletal and Skin Diseases. (n.d.). Rheumatoid Arthritis. Retrieved from <https://www.niams.nih.gov/health-topics/rheumatoid-arthritis>
3. American College of Rheumatology. (n.d.). Adalimumab (Humira). Retrieved from <https://www.rheumatology.org/I-Am-A-Patient/Caring-for-Your-Skin/Adalimumab-Humira>