Humira is a Food and Drug Administration (FDA)-approved brand-name drug. It can help treat several conditions, and some parts of Medicare may cover it.

Humira contains the active drug adalimumab. It is classified as a tumor necrosis factor (TNF) blocker.

This article will discuss Humira, including when doctors prescribe it and whether or not Medicare will provide coverage for it. It will also look at the associated costs and possible financial help.

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.

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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.

Doctors 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:

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 and thereby easing the condition.

Humira’s manufacturers are AbbVie.

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 vulnerable to infections.

Humira may also have mild-to-serious side effects, including:

  • mild side effects, such as:
  • 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 doctor as soon as possible.

A generic drug contains the same active ingredients as the brand-name drug. It must work in the body in the same way as the brand-name version.

Manufacturers can produce generics after the original patent expires. Currently, a new patent on a drug will last for 20 years. However, there are other factors that affect when a manufacturer can make a generic or biosimilar drug.

AbbVie are the manufacturers of Humira. The original patent expired in 2016. The FDA approved the first biosimilar drug to Humira in 2016.

Since other patents affect this drug, companies cannot sell biosimilar products in the United States until 2023. This essentially means that there will be no generic option for Humira in the U.S. until 2023.

Federally funded Medicare provides health insurance for people aged 65 years and above in the U.S. 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.
  • Part C, or Medicare Advantage, offers an alternative to original Medicare (parts A and B).
  • Part D offers coverage for prescription drugs.

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.

If a person self-administers Humira, Medicare Part D will cover the prescription drug cost. Many Part C, or Medicare Advantage, plans may also cover the drug, though a person will need to check with their 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.

One 2019 study evaluated the median cost of 49 brand-name drugs from 2012–2017. It found that the median cost of Humira in 2017 was $4,338 per month.

Another study, this time from 2020, found costs for Humira at $5,168 per month. The cost of a 20-milligram injection rose from $1,895 in 2010 to $5,300 in 2019.

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.

The Medicare Part D deductible has a maximum of $445 for 2021. After a person pays the deductible, the policy begins paying benefits.

After both the plan and the person with the plan have paid a total of $4,130 in 2021, the person will enter the coverage gap. During this time, they will pay no more than 25% of the cost of brand-name drugs such as Humira.

After the person and the plan have spent $6,550 in 2021, the person will enter the catastrophic coverage phase. During this time, the person will pay only a small copayment or coinsurance for all their drugs for the rest of the year.

Some Medicare Advantage plans may have a $0 deductible for drug coverage.

If a person gets coverage through Medicare Part B, they will generally pay the monthly premium, which $148.50 per month in 2021. They may also have an annual deductible to pay, which is $203 in 2021.

A person may be able to get some help with drug costs through programs such as Medicaid and Extra Help. Some drug companies also offer assistance programs.

The following sections will look at these options in more detail.

Medicaid

This state and federally funded program helps people with limited incomes and resources. Each state has different eligibility rules, but some provide help with the costs of prescriptions.

Extra Help

This Medicare program 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 2021, this limit is $9.20 for each covered brand-name drug and $3.70 for each covered generic drug.

Supplemental Security Income

This federally funded income program helps people meet basic needs for food, shelter, and clothing. The Social Security Administration run this program.

Drug company programs

Some drug companies have programs that help people cover the cost of the medication.

Humira’s manufacturers are AbbVie, and the company’s patient assistance foundation may provide help with the cost of medications to people who meet certain criteria.

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 provider can teach them how to self-administer the injection at home. Medicare Part D usually covers this medication in these circumstances.

Medicare Part B may cover the drug in special circumstances. Humira can cost more than $5,000 per month, depending on the amount a healthcare provider prescribes.

There are several programs that may help pay the cost of Humira for people with limited incomes and resources. These include Medicare Extra Help, Medicaid, and programs from the drug company that manufactures Humira.