Some parts of Medicare may cover the approved drug Humira. Humira can help treat various conditions, such as rheumatoid arthritis and plaque psoriasis.
Humira contains the active drug adalimumab. It is classified as a tumor necrosis factor (TNF) blocker.
This article discusses Humira, including when healthcare professionals prescribe it and whether Medicare will cover it. The article will also look at the costs associated with Humira and possible financial help a person can get.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Federally funded Medicare provides health insurance for people 65 years old and over in the United States. It also provides coverage for some people with certain disabilities.
The program has four parts:
- Part A provides hospital insurance.
- Part B is for medical insurance.
- Medicare Advantage (Part C) offers an alternative to Original Medicare (parts A and B).
- Part D offers coverage for prescription drugs.
Humira and Medicare
Humira is an injectable medication. People can self-administer it at home, though they may require training to do so. However, some people may need to get the injections at their doctor’s office or as an outpatient.
Individuals who are enrolled in a Medicare Part D plan may have coverage if the plan’s formulary includes Humira. A formulary is the list of prescription drugs that a plan covers.
Many Part C plans may also cover the drug, though a person will need to check with their Medicare Advantage plan provider.
If a person receives their Humira injections as an outpatient or in their doctor’s office, Medicare Part B may cover the cost.
Medicare can help individuals save quite a lot on Humira.
One subcutaneous kit with 2 doses of 10 milligrams (mg), or 0.1 milliliter (mL), each costs around $5,410. This means paying between $1,800 to $2,400 per month without a prescription drug plan.
In 2024, once individuals with a Medicare Part D plan spend $5,030 on drugs (combined with what the plan pays), they pay no more than 25% of the cost of prescription drugs. Once their out-of-pocket spending reaches $8,000, they will pay $0 for each covered prescription drug.
Are there any additional Medicare costs?
A person will generally have out-of-pocket costs to pay for a Medicare Part D plan or a Medicare Advantage policy. These costs can include premiums, deductibles, copays, and coinsurance.
Most people with Part D plans pay only their plan premium. People with an income of more than $103,000 will have to pay an extra fee on top of their monthly premium. The average monthly premium in 2024 for Part D plans is $55.50.
To get a Part D plan, a person must have both Part A and Part B. Most people do not pay a monthly premium for Part A. However, those who do not qualify for premium-free Part A will pay a monthly premium up to $505.
Part B monthly premium for people with incomes of $103,000 or less is $174.70.
Premiums for Medicare Advantage plans vary based on the provider and the area where a person lives.
A person may be able to receive help with drug costs through programs such as Medicaid and Extra Help.
Medicaid
Medicaid is a program funded by states and the federal government. It helps people with limited incomes and resources. Each state has different eligibility rules, but some provide help with the costs of prescriptions.
Extra Help
Extra Help is a Medicare program that helps pay the extra costs for prescription drugs. When a person is enrolled in this program, they will not pay more than the cost limit.
In 2024, this limit is $11.20 for each covered brand-name drug and $4.50 for each covered generic drug.
Humira is a drug that contains a biologic medication called adalimumab. It is in a class of drugs called TNF blockers.
Biologic drugs are made from living cells. Drugs in one particular class, such as TNF blockers, all work in a similar way. This is why they belong to the same group of drugs.
Healthcare professionals can prescribe Humira for both adults and children, and the drug can be effective in treating certain long-term conditions affecting the immune system. These include:
- psoriatic arthritis
- ulcerative colitis
- rheumatoid arthritis
- ankylosing spondylitis
- hidradenitis suppurativa
- plaque psoriasis
- juvenile idiopathic arthritis
- uveitis
People with one of these long-term conditions generally have higher levels of TNF-alpha, a protein that causes inflammation in the body. Humira may reduce inflammation by stopping the protein from working, which helps manage the condition.
How does a person take Humira?
People take Humira as a single dose injected beneath the skin. Administration can occur in one of three ways:
- a single-dose vial of liquid solution
- a single-dose pen
- a single-dose prefilled syringe
Does the drug have side effects?
This drug affects the immune system, which means that people may be more likely to get infections.
Humira may also have mild-to-serious side effects, including:
- mild side effects, such as:
- a stuffy nose
- sneezing
- a sore throat
- a headache
- a rash after the injection
- serious side effects that require urgent medical attention, such as:
- hives
- a swollen face, tongue, or throat
- difficulty breathing
In addition, a person taking Humira may develop lymphoma, which is a cancer of the lymphatic system. The symptoms of this condition may include:
- night sweats
- generally feeling ill
- swollen glands
- joint and muscle pain
- bruising easily
- shortness of breath
- loss of appetite
- a rash
If a person develops any of the symptoms above, they should contact their healthcare professional as soon as possible.
Learn more about .
A generic drug
Manufacturers can produce generics after the original patent expires. Currently, a new patent on a drug will last for
AbbVie is the manufacturer of Humira. The original patent for the drug expired in 2016. The Food and Drug Administration (FDA) approved the first biosimilar drug to Humira in 2016.
Since then, the FDA
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Humira contains a biologic medication called adalimumab. This drug can help treat certain long-term health conditions. People receive this drug via an injection under the skin.
A person’s healthcare professional can teach them how to self-administer the injection at home.
Medicare Parts D and B may cover the costs of Humira. Individuals will generally have out-of-pocket costs, including premiums, deductibles, and copays.
Medicare Advantage plans will also generally help cover the costs of drugs like Humira.
Several programs may help pay the cost of Humira for people with limited incomes and resources. These include Medicare Extra Help and Medicaid.