Does Medicare Cover Humira?

In this article...
  • Does Medicare cover Humira? If you have been prescribed Humira, you may wonder how you will pay for this expensive medication. Here is what you need to know.

Does Medicare cover Humira? If you’re enrolled in a Medicare Advantage plan that provides prescription drug benefits or have enrolled in a Medicare Part D plan, you may be covered for Humira. This drug is prescribed and filled at a pharmacy to be injected at home after your doctor has given you proper training on how to administer it to yourself. 

Your copayment for this medication will depend on the type of plan you’re enrolled in. Some Medicare Part D programs provide more comprehensive coverage than others and Medicare Advantage plans are provided through private insurers. Review the details of your plan to determine what your copayment and deductible will be for Humira. 

Is Humira a Tier 1 Drug? 

Humira is not a Tier 1 drug. While it may be rated slightly differently depending on the formulary, most insurance providers and prescription plans list Humira as a Tier 5 drug. This places it among the most expensive medications in terms of what you’ll have to pay for it, even with Medicare or insurance coverage. There are some ways that you can reduce the cost of Humira, fortunately. 

How Much Does Humira Cost Out-of-Pocket? 

Humira is an expensive medication that is injected once per month. A single dose may cost over $5,000 without Medicare or insurance coverage. Due to the expense of the drug, some people may choose to have it administered by their doctors. By doing so, they can receive coverage for the medication through Medicare Part B instead, as this is an outpatient service.  

There are some Advantage plans that provide drug coverage without a deductible. Check with your provider to see if your copayment is a flat rate or a percentage. In many cases, you may be required to pay a percentage of the cost instead of a flat rate. 

How Much Does Humira Cost on Medicare? 

For most people, determining the true cost of Humira can be confusing due to how Medicare Part D works. You need to meet your deductible before you’re able to receive coverage for expenses, and the most expensive Part D plans have a deductible of $435. The amount of copayment you’re responsible for varies by plan but is typically no more than 25%. This means that you’re looking at over $1,600 for the first month of treatment.  

Once you’ve paid more than $6,400 for a medication, however, the catastrophic coverage provision of your plan kicks in and you’d only pay a very low copayment for your medication beyond this point. So, by the fourth month, your out-of-pocket expense would drop to less than $151 per dose. Some people may be able to receive it for as little as $7 per month at this point. 

How Can I Get Humira for Free? 

If you can’t afford Humira and have a medical need for it that can be documented, there are other ways you can get it at a discounted price. In some cases, you may be able to get it free of charge. Here are some programs that you can look into for assistance. 

  • Medicaid: Your state Medicaid service may be able to provide financial assistance for your prescription medications. If you’re eligible to receive Medicaid, this is one way to reduce the cost of Humira. 
  • Extra Help Program: If you qualify for the Medicare Extra Help program, you won’t be charged more than $10 for any of your medications. If you’re having problems with your prescription drug copays, check to see if you can enroll in this program. 
  • AbbVie Patient Assistance Foundation: The makers of Humira have set up a program for those who are unable to afford their medication. You may be able to receive discounts or free medication by signing up for the program, as long as you meet the company’s requirements for assistance. 

Humira is an expensive medication, so while Medicare does cover Humira, it can still be difficult to meet your copayment. The good news is that there are limits to what you may be charged for the medication each year and assistance programs you can turn to if you are unable to afford it. You might even be able to get it for free.