Life Insurance And Humira: What You Need To Know

If you're looking to get life insurance while taking Humira, you may be concerned about the cost implications. Humira is a biologic medication used to treat inflammatory conditions like rheumatoid arthritis, and it's usually covered by Medicare Part D and Part C. It can be expensive, but there are ways to get help with the cost, such as Medicare Extra Help, Medicaid, and pharmaceutical assistance programs. You can also use a Humira Complete Savings Card to reduce your costs to as little as $0 a month. It's important to check with your insurance company to see if they cover Humira and understand your out-of-pocket expenses.

Medicare Part D and Part C coverage

Medicare Part D and Part C can cover the cost of Humira, a biologic medication used to treat inflammatory conditions like rheumatoid arthritis, plaque psoriasis, and Crohn's disease. Here is a detailed overview of Medicare Part D and Part C coverage for Humira:

Medicare Part D Coverage

Medicare Part D is the prescription drug coverage component of Medicare, which is a federal health insurance program. Part D plans are sold by private insurance companies and can be added to original Medicare coverage, which includes Part A (hospital insurance) and Part B (medical insurance).

When selecting a Part D plan, it is important to review the plan's formulary, or the list of prescription drugs the plan covers. Formularies often include multiple medications within each drug class, and drugs are typically divided into different tiers, with higher tiers costing more. Humira is generally included in the higher tiers of a plan's formulary due to its classification as a specialty drug.

• Deductible: The yearly deductible for all Part D plans cannot exceed $545. You must pay this amount out of pocket before your plan covers your Humira prescription.
• Coverage: After meeting your deductible, you will pay a copayment or coinsurance for your Humira prescription, depending on your specific plan.
• Donut Hole: Once you and your plan have spent a combined total of $5,030, you enter the coverage gap or "donut hole." During this phase, you will pay no more than 25% of the cost of brand-name drugs like Humira.
• Catastrophic Coverage: Once your out-of-pocket spending reaches $8,000, you will pay a small copayment or coinsurance for covered prescription drugs, including Humira.

Medicare Part C (Medicare Advantage) Coverage

Medicare Part C, also known as Medicare Advantage, is an alternative to original Medicare and is offered by private insurance companies. Part C plans typically bundle coverage from Parts A and B and often include prescription drug coverage (Part D).

When selecting a Part C plan, it is important to review the plan's formulary to ensure that Humira is covered. The cost of a Part C plan can vary based on your location and the specific plan you choose.

If you have a Medicare Advantage plan, you cannot enroll in a separate Part D plan for prescription drug coverage. Instead, you must include prescription drug coverage when selecting your Part C plan.

Additional Costs and Financial Assistance

In addition to the costs associated with your Medicare Part D or Part C plan, you may have other out-of-pocket expenses, such as premiums, deductibles, copays, and coinsurance. Here are some average costs for 2024:

• Part D Plan Premium: $55.50 per month on average.
• Part B Premium: $174.70 per month for individuals with incomes of $103,000 or less.
• Part A Premium: Up to $505 per month for those who do not qualify for premium-free Part A.
• Medicare Advantage Plan Premium: Varies based on the provider and your location.

If you have limited income or resources, you may be eligible for financial assistance to help cover the costs of Humira. Here are some programs to consider:

• Medicare Extra Help: This program assists individuals with limited income or resources in paying for prescription drugs. With Extra Help, you will pay no more than $11.20 for brand-name drugs like Humira.
• Medicaid: A federal and state program that helps pay for healthcare for those with lower incomes. Some state Medicaid programs may provide coverage for Humira, and certain states may also have their own pharmaceutical assistance programs.
• Programs of All-Inclusive Care for the Elderly (PACE): Available through Medicare and Medicaid, PACE can help you find care while living at home and may cover prescription drugs.
• Pharmaceutical Assistance Programs: Offered by drug manufacturers and foundations to help pay for specific medications.
• Pharmacy Discount Companies: Some companies offer coupons or discounts for Humira and other prescription drugs.

Humira's high cost

Humira is a very expensive medication, costing over $8,000 per month without insurance. This is due to its complex production process and use of DNA technology. Humira is a biologic drug, which means it is made of living cells and requires temperature-sensitive storage. The manufacturing process cannot be replicated, and it requires specialised materials and equipment for research, development, and testing.

The high cost of Humira is also influenced by the fact that there are few competitors in the market, allowing prices to stay higher. Humira is a best-selling medication and is in high demand due to the ageing population.

The cost of Humira can be reduced by using insurance benefits, coupons, manufacturer rebates, patient assistance programs, and asking healthcare providers for help. For those with commercial insurance, the Humira Complete Savings Card can reduce the cost of Humira to as little as $0 per month. Medicare and Medicaid may also provide coverage for Humira, depending on the individual's plan and location.

Help with prescription costs

If you are concerned about your Humira prescription coverage or out-of-pocket costs, you can call a HUMIRA Complete Insurance Specialist at 1.800.4HUMIRA (1.800.448.6472) for a benefits investigation. They are available Monday through Friday from 8:00 AM to 8:00 PM ET, except for holidays.

• Check your current 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 prescription at a specific specialty pharmacy
• Provide assistance if your pharmacy is unable to process your HUMIRA Complete Savings Card
• Help you find ways to lower your cost for Humira
• Suggest resources to help you understand the insurance process
• Help you navigate out-of-pocket costs or insurance coverage changes

Savings According to Insurance Status

If you have commercial insurance, you can use the HUMIRA Complete Savings Card to reduce your cost for Humira to as little as $0 a month, every month* Each time you fill your Humira prescription, make sure to present your Savings Card along with your prescription insurance card, and ask your pharmacist for the savings benefit.†

If you are receiving coverage through Medicare, you may be eligible for the Extra Help subsidy, which may lower the cost of Humira to $11.20 or less. An Insurance Specialist can help you understand what these costs mean to you and help you navigate changes in coverage.

If you are uninsured or having difficulty paying for your medication, you may qualify for the myAbbVie Assist Program. It provides Humira patient assistance at no cost to eligible patients who are typically uninsured and/or unemployed and meet certain income criteria.

Deductibles and Out-of-Pocket Costs

Depending on your individual plan and your health care needs, you may end up paying the full cost of medical and pharmacy expenses until the amount you've paid equals the amount of the deductible set by your insurance plan. This is called meeting your deductible. Be sure to set aside money in your budget for these expenses so that you're not caught off guard with a large, unexpected bill.

Prescription Rebates

If your pharmacy does not accept the HUMIRA Complete Savings Card or you’re no longer able to use it to receive instant savings, you may still be able to get Humira for as little as $0 a month using the HUMIRA Complete Prescription Rebate. Simply call 1.800.4HUMIRA (1.800.448.6472) and speak to one of our Insurance Specialists to see if this option is right for you.

Coupons, Copay Cards and Rebates

Humira offers may take the form of printable coupons, rebates, savings or copay cards, trial offers, or free samples. Certain offers may be printable from a website while others may require registration, completing a questionnaire, or obtaining a sample from a medical professional.

Humira's side effects

Humira (adalimumab) is a biologic medication used to treat several autoimmune disorders, including rheumatoid arthritis, psoriasis, and Crohn's disease. It works by blocking a protein called tumour necrosis factor (TNF) to calm inflammation.

Most Common Side Effects

• Injection site reactions: These are the most common side effects, affecting up to 37% of people. Symptoms include skin redness, irritation, swelling, pain, and rash near the injection site. These reactions usually occur during the first month of treatment.
• Headaches: About 12% of people treated with Humira experienced headaches.
• Skin rashes: People treated with Humira were twice as likely to develop skin rashes compared to those taking a placebo.

Serious Side Effects

• Infections: Humira lowers your immune response, making you more susceptible to infections such as tuberculosis (TB), viral, fungal, or bacterial infections. These infections can be serious and even life-threatening.
• Hepatitis B reactivation: For those who have had hepatitis B in the past, the virus may reactivate due to Humira weakening the immune system.
• Allergic reactions: Symptoms may include hives, trouble breathing, and swelling of the face, eyes, lips, or mouth.
• Nervous system problems: Signs and symptoms include numbness or tingling, vision problems, weakness in the arms or legs, and dizziness.
• Blood problems: Humira may decrease the number of blood cells that help fight infections or stop bleeding. Symptoms include a persistent fever, easy bruising or bleeding, and looking very pale.
• Heart failure: Signs and symptoms include shortness of breath, swelling of the ankles or feet, and sudden weight gain.
• Immune reactions: Immune reactions, such as a lupus-like syndrome, can cause chest discomfort or pain, shortness of breath, joint pain, or a rash that worsens in the sun.
• Liver problems: Symptoms include fatigue, jaundice, poor appetite, vomiting, abdominal pain, and nausea. Liver problems can lead to liver failure and death.
• Psoriasis: Humira may cause new or worsening psoriasis, characterised by red scaly patches or raised bumps filled with pus on the skin.

It is important to note that this list of side effects is not exhaustive, and you should consult your doctor if you experience any adverse effects while taking Humira.

Humira's active ingredient

Adalimumab is produced by recombinant DNA technology in a mammalian cell expression system and is purified by a process that includes specific viral inactivation and removal steps. It consists of 1330 amino acids and has a molecular weight of approximately 148 kilodaltons.

Adalimumab binds specifically to TNF-alpha and blocks its interaction with the p55 and p75 cell surface TNF receptors. Adalimumab also lyses surface TNF-expressing cells in vitro in the presence of complement. It does not bind or inactivate lymphotoxin (TNF-beta).

TNF is a naturally occurring cytokine that is involved in normal inflammatory and immune responses. Elevated concentrations of TNF are found in the synovial fluid of patients with rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, and ankylosing spondylitis and play an important role in both the pathologic inflammation and the joint destruction that are hallmarks of these diseases. Increased concentrations of TNF are also found in psoriasis plaques. In Ps, treatment with Humira may reduce the epidermal thickness and infiltration of inflammatory cells.

Frequently asked questions