Does Medicare Cover Humira?

• by Christian Worstell
• November 29, 2021

Reviewed by Hayden Gharibyar, Pharm.D.

HUMIRA (adalimumab) is the best-selling drug in the U.S., with over $21 billion worth of sales.¹ But is HUMIRA covered by Medicare?

While Medicare Part A and Part B don’t typically provide coverage for retail prescription drugs, HUMIRA is covered by most Medicare Part D prescription drug plans and Medicare Advantage plans that include drug coverage.²

Is HUMIRA covered under Medicare?

Original Medicare (Part A and Part B) does not provide any coverage for HUMIRA. Only a private Medicare insurance plan may provide such coverage, such as a Part D plan or a Medicare Advantage (Part C) plan.

• Medicare Part D plans provide coverage exclusively for prescription drugs.
  
  
• Medicare Advantage plans are an alternative to Original Medicare. These plans provide all the same benefits as Part A and Part B, and most Medicare Advantage plans also provide prescription drug coverage.
  
  A Medicare Advantage plan that covers prescription drugs is called a Medicare Advantage Prescription Drug plan (MA-PD).

How much does HUMIRA cost with Medicare?

With a Medicare Part D or Medicare Advantage plan, you may have an annual deductible. The deductible is the amount that you must pay out of pocket during the year before the plan pays anything for your prescription drugs.

Some Medicare Advantage plans and some Part D plans may include a $0 deductible for drug coverage.

Once you meet your plan deductible, you are typically required to make copayments (a flat fee) or coinsurance (a percentage) for your prescriptions that are covered by your plan.

Plan availability, costs and coverage can vary from one plan to another. Be sure to check with your Medicare plan formulary to find out if HUMIRA is covered by your Medicare plan and to find out more about your costs.

How does HUMIRA help treat arthritis?

HUMIRA is a brand name drug used to relieve pain and reduce inflammation for:

• Rheumatoid arthritis
• Psoriatic arthritis
• Ankylosing spondylitis
• Crohn’s disease
• Ulcerative colitis
• Psoriasis
• Hidradenitis suppurativa
• Uveitis
• Juvenile idiopathic arthritis

HUMIRA is an injectable drug typically taken with a syringe or pen device.

How much does HUMIRA cost without insurance?

HUMIRA can be very expensive when not covered by insurance. According to GoodRx, two injectable pens of HUMIRA have an average retail cost oof $9,338 if you are paying out of pocket.²

Compare Medicare plans with drug coverage

You can compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

A licensed insurance agent can also help you compare Medicare Advantage plans available in your area that provide prescription drug coverage.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover HUMIRA.

¹ Anderson, Maria. (Aug. 13, 2020). 20 top-selling drugs in the US. Becker's Hospital Review. https://www.beckershospitalreview.com/pharmacy/20-top-selling-drugs-in-the-us.html.​

² GoodRx. Humira. www.goodrx.com/humira.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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