Reviewed by Hayden Gharibyar, Pharm.D.
HUMIRA (adalimumab) was the best-selling drug in the U.S. in 2018, with almost $20 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
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.
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.
HUMIRA is a brand name drug used to relieve pain and reduce inflammation for:
HUMIRA is an injectable drug typically taken with a syringe or pen device.
HUMIRA can be very expensive when not covered by insurance. According to GoodRx injectable two pens of HUMIRA can cost close to $5,130.76 in 2019 if you are paying out of pocket.2
A licensed insurance agent can 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.
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1 Philippidis, Alex. Top 15 Best-Selling Drugs of 2018. (March 11, 2019). Genetic Engineering and Biotechnology News, 39(4). Retrieved from www.genengnews.com/a-lists/top-15-best-selling-drugs-of-2018.
2 GoodRx. Humira. Retrieved May 2019, from www.goodrx.com/humira.
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