Paul Sanchez
Humira is a biologic drug that is expensive to manufacture, and this cost is passed on to the consumer. As of April 1, 2024, most Aetna formularies no longer cover Humira. However, some Aetna Medicare plans may still cover the medication. The best way to confirm whether your Humira will be covered is to check your insurance plan's formulary, which is a list of drugs that an insurance company covers. If you have an Aetna insurance plan, your out-of-pocket costs for Humira will depend on the specifics of your plan.
| Characteristics | Values |
|---|---|
| Cost without insurance | $9,000+ for a one-month supply |
| Aetna coverage | Removed from most commercial pharmacy formularies as of April 1, 2024 |
| Alternative coverage | Members can transition to a preferred biosimilar or another approved medication |
| Cost with Aetna Medicare | $346–$2,109 per month |
| Cost variation | Depends on the pharmacy and the coverage plan |
| Ways to check coverage | Call Aetna, check member ID card, log in to Aetna account online, ask pharmacist |
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What You'll Learn
- Humira's high cost is due to its complex production process and use of DNA technology
- Humira is a biologic drug that costs over $9,000 for a one-month supply without insurance
- As of April 1, 2024, most Aetna formularies no longer cover Humira
- Some Aetna Medicare plans may completely cover Humira
- Humira is approved by the FDA to treat conditions such as rheumatoid arthritis, Crohn's disease, and ulcerative colitis
Humira's high cost is due to its complex production process and use of DNA technology
Humira is a biologic drug that is expensive to make and costs patients over $7,000 for a one-month supply without insurance. The high cost of Humira is due to its complex production process and use of DNA technology. Humira is a complex medication to make, and its production involves the use of DNA technology to create proteins for the drug. This process cannot be replicated, which makes it different from synthetically manufactured medications. The drug is created through genetic engineering, which is one of the reasons for its high price.
The cost of Humira can be difficult to understand, especially for those who are not used to taking medications that are so expensive. The drug's manufacturer, AbbVie, has carefully constructed patents to protect Humira from biosimilar competition. This has resulted in Humira being the world's best-selling drug for many years, with sales of $21 billion in 2022 alone. However, in recent years, biosimilars, or copycat versions, of Humira have entered the market, offering more affordable options for patients. These biosimilars are highly similar to Humira in terms of safety, purity, and potency, but they are priced lower.
The high cost of Humira has also led to insurance companies re-evaluating their coverage of the drug. As of April 1, 2024, Aetna removed Humira from most commercial pharmacy formularies, and affected members are required to transition to preferred biosimilars or other approved medications. The specific coverage and out-of-pocket costs for Humira depend on the individual's insurance plan and their specific situation. While some Aetna Medicare plans may completely cover the medication, others may require a copayment, which can range from $346 to $2,109 per month.
To reduce the cost of Humira, individuals can explore various strategies such as using insurance benefits, coupons, manufacturer rebates, patient assistance programs, and seeking help from healthcare providers. AbbVie, the manufacturer of Humira, also offers a Copay Savings Card program for those with commercial or private insurance. This program can help lower the out-of-pocket expenses associated with the drug. Additionally, individuals can explore biosimilars to Humira, such as Amjevita, Cyltezo, and Yusimry, which are now available in the market and offer more affordable alternatives.
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Humira is a biologic drug that costs over $9,000 for a one-month supply without insurance
Humira is a biologic drug that is expensive to make and thus costly for patients. The price of Humira is over $9,000 for a one-month supply without insurance. The high cost of the drug is due to its complex production process and use of DNA technology. As a specialty drug, it is likely to be on the highest drug tier, meaning the most expensive copay.
The manufacturer of Humira, AbbVie, provides a Copay Savings Card program to help patients afford the drug if they have commercial or private insurance. The co-pay assistance program is not available to patients with federal, state, or government-funded insurance programs such as Medicaid, Medicare, VA, or Tricare. The Humira Complete Savings Card can reduce out-of-pocket expenses to as little as $5 per prescription, with a maximum annual savings of $14,000 per year. If your pharmacy does not accept the Humira Complete Savings Card, you may still be able to get your prescription for as little as $5 a month using the Humira Complete Prescription Rebate.
If you do not have insurance, you may be eligible to receive Humira at no cost from the AbbVie Patient Assistance Program (myAbbVie Assist) or another foundation if you meet certain income criteria. Additionally, some state Medicaid programs may provide coverage for Humira for $20 or less per month, depending on your state plan. Medicare Part D cost is typically $346 to $2,109 per month, depending on the coverage phase.
There are also several biosimilar versions of Humira available, which may be more affordable options. These include Amjevita, Cyltezo, Hadlima, and Yusimry. Biosimilar medications are similar to brand-name biologic drugs but tend to cost less.
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As of April 1, 2024, most Aetna formularies no longer cover Humira
Humira is a biologic drug that is expensive to make, and this cost is passed down to consumers. It is a specialty drug, likely to be on the highest drug tier, meaning the most expensive copay. Aetna Medicare prescription drug plans are ineligible for the copay card, which can reduce prescription costs to $0 per month.
There are some alternatives to Humira that are covered by Aetna. Affected members are required to transition to a preferred biosimilar or another approved medication. These include a selection of biosimilar adalimumab products that are lower-cost alternatives, such as Cyltezo (adalimumab-adbm), Yusimry (adalimumab-aqvh), and Hulio (adalimumab-fkjp).
There are several ways to find out if your Humira prescription will be covered by Aetna. You can call Aetna directly and ask to be connected with someone who can provide detailed information about Humira coverage. You can also check your member ID card for a phone number for pharmacy benefits or log in to your Aetna account online to search for Humira coverage. Your pharmacist may also be able to help determine whether your plan covers Humira.
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Some Aetna Medicare plans may completely cover Humira
As of April 1, 2024, most Aetna formularies no longer cover Humira. However, some Aetna Medicare plans may completely cover the medication. Humira is a specialty drug, likely to be on the highest drug tier, which means the most expensive copay. The cost of Humira varies by pharmacy, but without insurance or discounts, you can expect to pay the average retail price of $9,283 for a one-month supply. This high cost is due to its complex production process and use of DNA technology.
If you have an Aetna Medicare Part D plan, you may pay $346–$2,109 per month, depending on which coverage phase you are in. To check your coverage for alternatives, you can contact your plan administrator or review the drug formulary online. You can also call Aetna directly and ask to be connected with someone who can provide detailed information about Humira coverage.
Aetna prescription plans cover thousands of drugs. The simplest way to find drugs covered under your specific plan is to log in to your member website. If you are an Aetna member, you can find your pharmacy plan name in your Summary of Benefits and Coverage (SBC). If you are considering an Aetna plan, ask your HR department for the plan name.
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Humira is approved by the FDA to treat conditions such as rheumatoid arthritis, Crohn's disease, and ulcerative colitis
As of April 1, 2024, most Aetna formularies no longer cover Humira. However, some Aetna Medicare plans may still cover the medication. Humira is a biologic drug that is expensive to make, and its cost is passed down to consumers. Without insurance or discounts, a one-month supply of Humira costs $9,283 on average.
Humira is a prescription medicine approved by the FDA to treat several conditions, including moderate to severe rheumatoid arthritis, Crohn's disease, and ulcerative colitis. It can be used alone, with methotrexate, or with certain other medicines. Humira may help prevent further damage to bones and joints and may improve patients' ability to perform daily activities.
For rheumatoid arthritis, the recommended subcutaneous dose of Humira for adults is 40 mg administered every other week. Methotrexate, other non-biologic DMARDS, glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), and/or analgesics may be continued during treatment with Humira. In some cases, increasing the dosing frequency to 40 mg every week or 80 mg every other week may provide additional benefits.
Humira is also used to treat moderate to severe Crohn's disease in adults and children aged 6 years and older. In clinical studies, many Crohn's patients on Humira achieved remission or significant symptom relief within 4 weeks.
Additionally, Humira is prescribed to treat moderate to severe ulcerative colitis in adults and children aged 5 years and older. Clinical studies have shown that Humira is effective in inducing remission in patients with ulcerative colitis. In one study, 18.5% of patients with moderate to severe ulcerative colitis achieved remission at 8 weeks compared to 9.2% on a placebo.
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Frequently asked questions
As of April 1, 2024, most Aetna formularies no longer cover Humira. However, some Aetna Medicare plans may completely cover the medication.
The best way to confirm whether your Humira will be covered or not is to check your insurance plan’s formulary, which is a list of drugs that an insurance company covers. You can do this by logging into your Aetna account online or calling Aetna directly.
If your Aetna plan does not cover Humira, you can transition to a preferred biosimilar or another approved medication. Lower-cost alternatives to Humira include Cyltezo (adalimumab-adbm), Yusimry (adalimumab-aqvh), and Hulio (adalimumab-fkjp).
If you have an Aetna Medicare Part D plan, you may pay $346–$2,109 per month, depending on which coverage phase you’re in. Without insurance or discounts, you can expect to pay the average retail price of $9,283 for a one-month supply.
