To help you get off to a good start with your HUMIRA prescription, we’ll explore the various types of insurance, the role of specialty pharmacies, and how our Insurance Specialists can help you understand your HUMIRA coverage.
The type of health insurance you have will determine what’s covered, what’s not, how much you pay for prescriptions and medical services, and what additional savings you may be eligible for. Let’s take a look at each.
Commercial, also known as private insurance, is coverage you get from your employer or buy directly from insurance companies through the marketplace. Most people with this type of coverage are eligible for the HUMIRA Complete Savings Card, which means you may pay as little as $5 a month, every month, for your HUMIRA prescription.*
*Terms and Conditions apply. This benefit covers HUMIRA® (adalimumab) alone or, for rheumatology patients, HUMIRA plus one of the following medications: methotrexate, leflunomide (Arava®), or hydroxychloroquine (Plaquenil®). Eligibility: Available to patients with commercial prescription insurance coverage for HUMIRA who meet eligibility criteria. Copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare[including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving prescription drug cover age under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the HUMIRA Complete Savings Card and patient must call HUMIRA Complete at 1.800.4HUMIRA (1.800.448.6472) to stop participation. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from the HUMIRA Complete Program from any third-party payers. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This is not health insurance. Please see full Terms and Conditions.
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Medicare is a federal health insurance program for people 65 and older and others with certain disabilities. With Medicare, it’s important to note that prescription coverage is available through many Medicare Advantage Plans (Part C), and Supplemental Plans (Part D)—but you must enroll separately.
Medicare Advantage Plans (Part C)
Medicare Advantage Plans are private insurance plans that provide Parts A and B Medicare coverage (hospital and medical insurance), and generally includes prescription coverage.
Supplemental Plans (Part D)
This is a separate prescription coverage option that you can add to Medicare Parts A and B. You must enroll in Medicare Part D.
People on Medicare who need help paying for their prescriptions may be eligible to receive a low income subsidy (also known as LIS or Extra Help).
To find out if you’re eligible, there are three ways to apply:
If you're not eligible, HUMIRA may still be available at no additional cost. Please call 1.800.4HUMIRA (1.800.448.6472) to talk to one of our Insurance Specialists for assistance.
Medicaid is jointly run by the federal government and individual states. It provides medical assistance for low-income individuals and families. State Medicaid programs can provide coverage for HUMIRA—which may vary depending on where you live. To find out the specific coverage policy and information for a particular state Medicaid program, please contact 1.800.4HUMIRA (1.800.448.6472).
Everyone’s situation is different, and prescription drug plans vary widely. Be sure to speak with your plan’s representatives or a HUMIRA Complete Insurance Specialist† about the prescription drug benefit on your plan. To speak with an Insurance Specialist, call 1.800.4HUMIRA (1.800.448.6472).
†Insurance Specialists are available Monday through Friday from 8:00 AM to 8:00 PM Eastern Time, except for holidays.
A specialty pharmacy distributes complex medications that require special adminstration, storage and/or handling, such as refrigeration.
These prescriptions are either mailed or couriered to you. The use of a specialty pharmacy is often required by your insurance and typically takes a few days for approval.
See how your HUMIRA prescription gets filled, from your doctor’s office to your front door.
Connect with one of our Insurance Specialists to get answers right over the phone. You may receive a comprehensive summary of insurance benefits, including out of pocket costs for HUMIRA, and information about the insurance process, including appeals. Plus, you can see if you are eligible for the HUMIRA Complete Savings card.
Check your insurance coverage and determine your insurance benefits
Check to see if your insurance plan requires prior authorization for HUMIRA or if you need to fill your HUMIRA prescription at a specific specialty pharmacy
Help you find ways that may lower your cost for HUMIRA
Suggest resources to help you understand the insurance process
Insurance Specialists are available Monday through Friday from 8:00 AM to 8:00 PM Eastern Time, except for holidays. To speak with one of our Insurance Specialists, call 1.800.4HUMIRA (1.800.448.6472).
Open enrollment is the time of year when you can renew your current insurance plan, switch to a different plan, and add or drop coverage. Keep in mind that even if you choose to stay with your current plan, it’s important to check to see if the plan made changes to your co-pay and other out-of-pocket costs, your provider network and your prescription coverage. If your plan no longer covers your prescription drugs, now may be the time to consider other plan options.
If you have commercial insurance, open enrollment is typically from early November through mid-December. For Medicare, it runs from mid-October through early December.
Choosing between insurance plans can be confusing. To best prepare for open enrollment, use any of these questions to start a conversation with your Nurse Ambassador or Insurance Specialist:
If you’re comparing plans, use the Insurance Comparison Chart to make an informed choice.