Humira Overview: Uses, Dosage, Side Effects, and More
Humira (adalimumab) is a prescription drug that's used to treat certain types of arthritis and other inflammation-related diseases. It comes as a liquid solution for injection under your skin.
Specifically, Humira is used to treat:
rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, and ankylosing spondylitis in adults
plaque psoriasis in adults
juvenile idiopathic arthritis in children
Crohn's disease and ulcerative colitis in adults and some children
hidradenitis suppurativa (a skin condition) in adults and some children
uveitis (an eye condition) in adults and some children
To learn more about Humira's uses, see the ' What is Humira used for? ' section.
What is Humira?
Humira (pronounced hu-MARE-ah) is a biologic medication. A biologic is made from parts of living organisms.
The active ingredient in Humira is adalimumab. (An active ingredient is what makes a medication work.)
There are also biosimilar versions of Humira, such as Amjevita, Cyltezo, and others. Biosimilar drugs are medications that are similar to a brand-name biologic drug. Biosimilars are considered as safe and effective as brand-name biologic drugs and tend to cost less.
Humira belongs to a group of drugs called tumor necrosis factor inhibitors, which help reduce inflammation in the body.
What is Humira used for?
If you have a certain type of arthritis or a disease related to inflammation, your doctor may prescribe Humira for you.
Humira is used in certain situations to treat the following conditions:
Rheumatoid arthritis: Humira is used to treat rheumatoid arthritis (RA) in adults. The drug can help slow the worsening of this condition. With RA, you have inflammation in your joints. But you may also have problems with other organs in your body.
Juvenile idiopathic arthritis: Humira is used to treat moderate to severe juvenile idiopathic arthritis (JIA) in children ages 2 years and older. JIA is a type of arthritis that occurs in children.
Psoriatic arthritis: Humira is used to treat psoriatic arthritis (PsA) in adults. The drug helps to slow the worsening of this condition. With PsA, you have inflammation in your joints, and you may also have plaques on your skin, similar to those seen with plaque psoriasis (see below).
Ankylosing spondylitis: Humira is used to treat ankylosing spondylitis (AS) in adults. AS and RA are very similar diseases. But people with AS usually have long-lasting lower back pain. This is unlike people with RA, who usually have long-lasting pain in joints in their hands, wrists, or knees.
Crohn's disease: Humira is used to treat moderate to severe Crohn's disease in adults and children ages 6 years and older. Crohn's disease is an inflammatory disease that causes swelling in your intestines.
Ulcerative colitis: Humira is used to treat moderate to severe ulcerative colitis (UC) in adults and children ages 5 years and older. With UC, you have swelling in your lower intestine.
Plaque psoriasis: Humira is used to treat moderate to severe plaque psoriasis in adults. With plaque psoriasis, you may have plaques on the skin of your scalp or trunk, or the skin around your joints. (Plaques are rough, thick, or scaly patches.) Some people with plaque psoriasis develop psoriatic arthritis.
Hidradenitis suppurativa: Humira is used to treat moderate to severe hidradenitis suppurativa (HS) in people ages 12 years and older. HS is a skin condition that causes sores on your underarm (axilla) or groin, around your anus, between your anus and urethra, and under your breasts.
Uveitis: Humira is used to treat uveitis in adults and children ages 2 years and older. With uveitis, you have inflammation in your eyes that can cause pain and vision loss.
How does Humira work?
Adalimumab, the active ingredient in Humira, targets a protein in your body called tumor necrosis factor (TNF). This protein increases inflammation in your body.
People with inflammatory diseases, such as rheumatoid arthritis or psoriatic arthritis, may have too much TNF in their bloodstream and joints. Blocking TNF is how Humira works for the conditions listed above.
What is Humira's dosage?
The Humira dosage your doctor prescribes will depend on several factors. These include:
the type and severity of the condition you're using Humira to treat
your age
other medical conditions you may have
For some conditions, you may need to start treatment with a loading dose of Humira. A loading dose is a dose that's larger than your regular dose. It allows the drug to start working quickly in your body.
Be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
How to take Humira
You'll inject Humira under your skin. Your doctor will show you how to give Humira injections to yourself. Be sure to let your doctor know if you have any questions or concerns about administering the drug to yourself.
You'll inject Humira under the skin of:
your abdomen, staying 2 inches away from your belly button
the front of your thighs
Every time you inject a dose of Humira, you should choose a different injection site. And each new injection should be given at least 1 inch away from your last injection site.
You should avoid injecting Humira into skin that's:
sore
bruised
discolored
hard
scarred, including having stretch marks
Questions about taking Humira
Here are answers to some common questions about taking Humira.
What if I miss a dose of Humira? If you miss a dose of Humira, take the missed dose as soon as you remember. Then continue taking Humira doses at your regularly scheduled times. How many days late you can take a Humira dose depends on when your next dose is scheduled. So if it's close to when your next dose is due, just skip the missed dose. If you're unsure of when to take a missed dose of Humira, talk with your doctor or pharmacist.
Will I need to use Humira long term? You'll likely need to take Humira long term. This is because most of the conditions Humira treats are long lasting. Talk with your doctor about how long you'll need to take Humira.
Should I take Humira with food? You don't have to. How well your body absorbs Humira doesn't depend on whether you have a full or empty stomach.
How long does Humira take to work? Depending on the reason you're taking Humira, it may take several months for the drug to work. For example, in studies, people with rheumatoid arthritis saw improvement in their condition after 6 months of treatment. And this improvement was maintained after 1 year when treatment was continued. You might notice Humira working sooner than this for your condition. Talk with your doctor to find out when you should expect to experience a reduction in your symptoms.
Overdose
Do not take more Humira than your doctor prescribes, as this can lead to harmful effects.
What to do in case of overdose
Call your doctor if you think you've taken too much Humira. You can also call 800-222-1222 to reach America's Poison Centers or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.
What are Humira's side effects?
Like most drugs, Humira may cause mild to serious side effects. The following lists contain some of the more common side effects Humira may cause, but they don't include all possible side effects.
Keep in mind that side effects of a drug can depend on:
your age
other health conditions you have
other medications you take
The most common Humira side effects reported in the drug's prescribing information include:
upper respiratory infections
sinusitis
injection site reactions
headache
rash
What does Humira cost?
Whether you have health insurance or not, cost may be a factor when you're considering Humira. What you'll pay for Humira may depend on several things, such as your treatment plan and the pharmacy you use.
Here are a few things to consider regarding cost:
Cost information and savings coupons: You can visit Optum Perks for price estimates of Humira. These estimates are based on the use of Optum Perks coupons. Note: Optum Perks coupons cannot be used with insurance copays or benefits.
Generic or biosimilar form: Humira is available as the biosimilar drug Amjevita. Similar to generic drugs, biosimilars often cost less than brand-name drugs. Talk with your doctor if you'd like to know whether Amjevita or another biosimilar version of Humira could be a less expensive option for you.
Savings options: If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. The Humira manufacturer's website may also have some savings options.
Humira interactions
Humira can interact with several other medications. It can also interact with certain vaccines.
Before using Humira, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, or supplements you use. Sharing this information can help you avoid potential interactions.
Similar drugs
Other drugs may be available that can treat your condition. If you'd like to explore an alternative to Humira, talk with your doctor. They can tell you about other medications that might work well for you.
The following drugs are similar to Humira:
etanercept (Enbrel)
infliximab (Remicade)
ustekinumab (Stelara)
secukinumab (Cosentyx)
vedolizumab (Entyvio)
upadacitinib (Rinvoq)
certolizumab (Cimzia)
risankizumab-rzaa (Skyrizi)
tofacitinib (Xeljanz)
For information about how some of these alternatives compare with Humira, see these articles:
Factors to consider before using Humira
The following is important information to consider and discuss with your doctor or pharmacist before using Humira.
Pregnancy and Humira
Adalimumab, the active ingredient in Humira, passes through the placenta to the developing fetus during the last trimester of pregnancy. But studies don't show a link between Humira use and development problems in pregnancy.
It's thought that having unmanaged rheumatoid arthritis or inflammatory bowel disease (such as Crohn's disease) can negatively affect pregnancy. And keep in mind that Humira is used for those conditions.
Also, because of how Humira works, doctors will weigh the benefits and risks of giving certain vaccines to babies exposed to Humira during the last trimester of pregnancy.
If you're pregnant or considering pregnancy, talk with your doctor before starting Humira.
Humira and breastfeeding
Humira does pass into breast milk. But side effects from Humira in children who are breastfed haven't been reported. Also, Humira doesn't seem to decrease milk production in people who are breastfeeding.
If you're breastfeeding, your doctor will weigh the benefits and risks of Humira treatment. Be sure to talk with your doctor if you'll be breastfeeding while taking Humira.
Humira precautions
Boxed warnings
Humira has boxed warnings about the risk of serious infections and cancer. A boxed warning is the most serious warning from the FDA about drug effects that may be dangerous.
Risk of serious infections. Taking Humira can increase your risk for getting a serious infection. This includes tuberculosis, fungal infections, and other rare infections. It may also include bacterial sepsis (a life threatening illness that can result from an infection).
Symptoms of a serious infection will vary, but they may include:
breathing quickly
fast heart rate
being confused or disoriented
fever
chills
rash
cough
If you develop a serious infection or sepsis while you're taking Humira, your doctor will have you stop taking the drug. Call your doctor right away if you have any symptoms of infection while using this drug.
Your doctor will also check you for tuberculosis before you start using Humira. And during treatment with Humira, your doctor will monitor you for any signs or symptoms of tuberculosis.
Risk of cancer. Some children and adolescents have developed certain types of cancer when taking Humira, such as lymphoma. (This is a type of cancer that affects the lymphatic system.) Other cancers that can be fatal were also reported.
Before prescribing Humira, your doctor will consider the benefits and risks of using this drug if you already have cancer. If you develop cancer while you're taking Humira, your doctor will also weigh the benefits and risks of Humira treatment. Your doctor may recommend that you stop taking Humira.
Other precautions
Before using Humira, discuss your health history with your doctor. Humira may not be right for you if you have certain medical conditions or other factors affecting your health.
Be sure to talk with your doctor if any of the following apply to you:
Frequently asked questions about Humira
Here are answers to some commonly asked questions about Humira.
Does Humira cause weight gain or weight loss?
No, Humira doesn't cause weight gain or weight loss. But if you get a serious infection during Humira treatment, you might lose weight. And serious infections are a possible side effect of this drug.
Also, new or worsening heart failure can cause a rapid increase in weight. Heart failure is a possible side effect of Humira.
If you have unexplained weight gain or weight loss when using Humira, tell your doctor. They can try to determine what might be causing your weight change.
If you're concerned about any other weight changes while you're taking Humira, talk with your doctor. They can provide tips to help you manage a body weight that's healthy for you.
Will I have hair loss with Humira?
Possibly. Hair loss wasn't reported as a side effect in Humira's studies. But there have been reports of hair loss in people taking Humira since the drug was approved.
If you notice you're losing hair while you're taking Humira, talk with your doctor.
What will happen if I stop taking Humira? Will I have withdrawal symptoms?
If you stop taking Humira, the symptoms of your condition may come back. But you won't have withdrawal symptoms from the medication itself. (Withdrawal refers to symptoms that can happen if you stop taking a medication that your body is dependent on. Dependence means the body needs the medication to function like usual.)
If you need to stop taking Humira, your doctor will closely monitor you for symptoms of your condition. If your symptoms return, your doctor may recommend that you restart treatment with Humira. Or they may suggest another drug to manage your condition.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
CBS News
13 minutes ago
- CBS News
Fallout continues after federal raid; officials say drugs is a growing concern in area
Continued fallout from federal raid on Lake Street; officials say drugs are a problem in the area Continued fallout from federal raid on Lake Street; officials say drugs are a problem in the area Continued fallout from federal raid on Lake Street; officials say drugs are a problem in the area Fallout continues after a chaotic clash between protesters and law enforcement serving a drug trafficking warrant on Lake Street in Minneapolis Tuesday. While residents and local leaders denounced the tactics, they do say drugs are a growing problem in Minneapolis. Healthcare officials are sounding the alarm too. The chaotic clash is gone but questions remain — about the optics in which federal agents went about the raid at a Mexican restaurant on Lake Street. Many believing the raid was tied to immigration enforcement, but the Department of Homeland Security calls it a "groundbreaking criminal operation." Local leaders say the search warrant was connected to "drugs and money laundering." "I don't know one person who's ok with drug smuggling in our communities," said Hennepin County Sheriff Dawanna Witt. In fact — Sheriff Witt says Tuesday's operation needed to be done pointing to an uptick in overdoses. "Look at the stats, Od's are going back up already, we have to do this work," Witt said. According to Hennepin Healthcare, the number of non-fatal overdoses is up about 45% compared to last year. Dr. Tim Kummer, the Assistant Medical Director of Hennepin EMS calls the uptick troubling. "When you have an increase in non-fatal overdoses, you'll inevitable have an increase in fatal overdoses," Kummer said. Healthcare leaders say they are working on a plan to get ahead of this spike in non-fatal overdoses before they become fatal. Back on E. Lake Street, those living in the area say they see the drug use in real time. "We are all the time threaten by violence by drug dealers in their corners," said business owner Rodrigo Cardoso.
CNN
an hour ago
- CNN
New documents give insight into Luigi Mangione's state of mind in the months leading up to the murder of UnitedHealthCare's CEO
Diary entries written by Luigi Mangione reveal the now 27-year-old's detailed thinking ahead of the alleged killing of UnitedHealthcare CEO Brian Thompson last year, a new court filing shows. A red notebook was recovered by police at the time of his December 9 arrest at a McDonald's in Altoona, Pennsylvania. In diary writings contained in that notebook, Mangione vents about his frustrations with the health insurance industry and his intent to carry out an attack. The entries also shed light on Mangione's focus on the court of public opinion and how he intended to gain widespread support through the alleged killing. The new filing from the Manhattan District Attorney's Office is a response to a motion filed last month by Mangione's defense team seeking to stay or dismiss the New York case against him. Mangione has pleaded not guilty to all federal and state charges against him. In August 2024, roughly four months before he allegedly shot and killed Thompson in midtown Manhattan, Mangione wrote in his diary: 'I finally feel confident about what I will do. The details are coming together. And I don't feel any doubt about whether it's right/justified. I'm glad-in a way-that I've procrastinated bc it allowed me to learn more about [UnitedHealthcare].' 'The target is insurance. It checks every box,' he continued in the August 15 entry. That summer, Mangione – who had an active social media presence for years – appeared to stop posting online, prompting worried messages from some of his friends. In October, another diary entry reads, '1.5 months. The investor conference is a true windfall. It embodies everything wrong with our health system, and-most importantly-the message becomes self-evident. The problem with most revolutionary acts is that the message is lost on normies.' He then goes on to explain his reasoning for not targeting the health care industry through a bombing, writing that 'innocent' lives would be unaffected by his attack. At the time of that writing, Mangione – the privileged scion of a well-to-do family, high school valedictorian and Ivy League graduate – had reportedly vanished from view of his loved ones. 'Nobody has heard from you in months, and apparently your family is looking for you,' one user posted on X in October, tagging an account belonging to Mangione. 'I don't know if you are okay,' another posted. Mangione allegedly gunned down Thompson on a busy sidewalk as Thompson walked toward a Manhattan hotel hosting his company's investors' conference, authorities said. The suspect appeared to be driven by anger against the health insurance industry and against 'corporate greed' as a whole, according to an NYPD intelligence report obtained by CNN. The previously unreported writings lay bare Mangione's plans to target the insurance industry. Prosecutors argue in the filing that his actions motivated a barrage of threats against health insurance workers and made them worry for their safety. CNN has reached out to Mangione's attorneys for comment. In the months since the fatal shooting of Thompson, Mangione has become a cult-like figure. There has been a massive outpouring of support on social media and at his court appearances from people with deep frustration and anger at the American for-profit health care system. They see the American health insurance industry as broken, overly expensive and quick to deny coverage. The majority of insured US adults had at least one issue with their health insurance within the span of a year, including denial of claims, according to a survey released in June 2023 by nonprofit health policy research group KFF. A legal defense fund in support of Mangione has raised more than $1 million as of Wednesday. In the diary entries, Mangione – who allegedly used a ghost gun to carry out the killing of Thompson – criticizes bombers: 'They commit an atrocity whose horror either outweighs the impact of their message, or whose distance from their message prevents normies from connecting the dots.' In the October 22 entry, Mangione went on to ask, 'Do you bomb the HQ? No. Bombs=terrorism. Such actions appear the unjustified anger of someone who simply got sick/had bad luck and took their frustration out on the insurance industry, while recklessly endangering countless employees.' Instead of carrying out a bombing, targeting the CEO at the conference is 'targeted, precise and doesn't risk innocents,' adding that it would bring light to the event and the 'greed' of its attendees. He also appears to reference the Unabomber, Ted Kaczynski, calling such attacks 'counter-productive' because they would lose public support. 'Normies categorize him as an insane serial killer, focus on the act/atrocities themselves, and dismiss his ideas,' Mangione writes. 'And most importantly—- by committing indiscriminate atrocities he becomes a monster, which makes his ideas those of a monster, no matter how true. He crosses the line from revolutionary anarchist to terrorist-the worst thing a person can be.' Mangione's intentions to target the insurance industry were made clear by the writings, which prosecutors say prove that he committed first-degree murder in furtherance of terrorism, the Wednesday filing states. UnitedHealthcare became a symbol of the health insurance industry that Mangione aimed to abolish, prosecutors said. He was not insured by UnitedHealthcare from 2014 to 2024, prosecutors say, but at the time of his arrest, Mangione allegedly had a handwritten notebook that expressed 'hostility toward the health insurance industry and wealthy executives in particular,' according to a federal complaint. 'Having no business relationship with them, he chose UHC solely because they were the largest health insurance company and one of the country's largest companies by market cap,' the new filing said. Notably, three 9mm shell casings from the crime scene had the words 'delay,' 'deny' and 'depose' written on them, the NYPD has said, an apparent nod to a 2010 book critiquing insurance industry tactics. Mangione hoped the alleged killing would intimidate health insurance employees, cause the public to focus on greed in the health insurance industry and prevent investors and financial analysts from investing in the industry, according to the filing. The killing of the husband and father of two struck fear in C-suites across the country, as an NYPD intelligence report obtained by CNN warned online rhetoric could 'signal an elevated threat facing executives in the near-term.' Mangione inspired some individuals to partake in a 'broader campaign of threats of violence' against UnitedHealthcare employees and other health insurance workers, the document says. In the aftermath of Thompson's killing, threats had been aimed at other UnitedHealthcare executives and employees also reported feeling unsafe, prosecutors said. UnitedHealthcare doctors sending out denial letters to customers feared for their safety, requesting that they not be required to sign their names to the letters, prosecutors said. Some physicians quit their jobs out of fear of retribution. The company advised employees not to wear company branded clothes, and online threats prompted it to pull pictures of senior executives from its website, the filing states. Meanwhile, the company's call center received a slew of death threats, the filing said. 'You are gonna hang,' one caller said. 'That means that the killing of Brian Thompson was just a start. There are a lot more that are gonna be taken out. The only question is whether you're gonna be their collateral damage when its done or not.' Police were hired to protect the company's headquarters in Minnesota. Threats were also made to employees at the company's New York City office. Forty company executives received personal security, with one executive who received threats dying her hair and moving into another home out of fear for her safety, according to the filing. Other health insurance executives, including Emblem Health's CEO, were also targeted. Posters were put up outside the company's headquarters with the CEO's picture that read 'Health Care CEOs should not feel safe. Deny, Defend Depose.' The killing 'demonstrated his concerted effort to broadcast his message of ideological intimidation as broadly and loudly as possible,' prosecutors said. CNN's Kara Scannell, Zoe Sottile, Lauren del Valle and Michelle Watson contributed to this report.
CNN
an hour ago
- CNN
New documents give insight into Luigi Mangione's state of mind in the months leading up to the murder of UnitedHealthCare's CEO
FacebookTweetLink Follow Diary entries written by Luigi Mangione reveal the now 27-year-old's detailed thinking ahead of the alleged killing of UnitedHealthcare CEO Brian Thompson last year, a new court filing shows. A red notebook was recovered by police at the time of his December 9 arrest at a McDonald's in Altoona, Pennsylvania. In diary writings contained in that notebook, Mangione vents about his frustrations with the health insurance industry and his intent to carry out an attack. The entries also shed light on Mangione's focus on the court of public opinion and how he intended to gain widespread support through the alleged killing. The new filing from the Manhattan District Attorney's Office is a response to a motion filed last month by Mangione's defense team seeking to stay or dismiss the New York case against him. Mangione has pleaded not guilty to all federal and state charges against him. In August 2024, roughly four months before he allegedly shot and killed Thompson in midtown Manhattan, Mangione wrote in his diary: 'I finally feel confident about what I will do. The details are coming together. And I don't feel any doubt about whether it's right/justified. I'm glad-in a way-that I've procrastinated bc it allowed me to learn more about [UnitedHealthcare].' 'The target is insurance. It checks every box,' he continued in the August 15 entry. That summer, Mangione – who had an active social media presence for years – appeared to stop posting online, prompting worried messages from some of his friends. In October, another diary entry reads, '1.5 months. The investor conference is a true windfall. It embodies everything wrong with our health system, and-most importantly-the message becomes self-evident. The problem with most revolutionary acts is that the message is lost on normies.' He then goes on to explain his reasoning for not targeting the health care industry through a bombing, writing that 'innocent' lives would be unaffected by his attack. At the time of that writing, Mangione – the privileged scion of a well-to-do family, high school valedictorian and Ivy League graduate – had reportedly vanished from view of his loved ones. 'Nobody has heard from you in months, and apparently your family is looking for you,' one user posted on X in October, tagging an account belonging to Mangione. 'I don't know if you are okay,' another posted. Mangione allegedly gunned down Thompson on a busy sidewalk as Thompson walked toward a Manhattan hotel hosting his company's investors' conference, authorities said. The suspect appeared to be driven by anger against the health insurance industry and against 'corporate greed' as a whole, according to an NYPD intelligence report obtained by CNN. The previously unreported writings lay bare Mangione's plans to target the insurance industry. Prosecutors argue in the filing that his actions motivated a barrage of threats against health insurance workers and made them worry for their safety. CNN has reached out to Mangione's attorneys for comment. In the months since the fatal shooting of Thompson, Mangione has become a cult-like figure. There has been a massive outpouring of support on social media and at his court appearances from people with deep frustration and anger at the American for-profit health care system. They see the American health insurance industry as broken, overly expensive and quick to deny coverage. The majority of insured US adults had at least one issue with their health insurance within the span of a year, including denial of claims, according to a survey released in June 2023 by nonprofit health policy research group KFF. A legal defense fund in support of Mangione has raised more than $1 million as of Wednesday. In the diary entries, Mangione – who allegedly used a ghost gun to carry out the killing of Thompson – criticizes bombers: 'They commit an atrocity whose horror either outweighs the impact of their message, or whose distance from their message prevents normies from connecting the dots.' In the October 22 entry, Mangione went on to ask, 'Do you bomb the HQ? No. Bombs=terrorism. Such actions appear the unjustified anger of someone who simply got sick/had bad luck and took their frustration out on the insurance industry, while recklessly endangering countless employees.' Instead of carrying out a bombing, targeting the CEO at the conference is 'targeted, precise and doesn't risk innocents,' adding that it would bring light to the event and the 'greed' of its attendees. He also appears to reference the Unabomber, Ted Kaczynski, calling such attacks 'counter-productive' because they would lose public support. 'Normies categorize him as an insane serial killer, focus on the act/atrocities themselves, and dismiss his ideas,' Mangione writes. 'And most importantly—- by committing indiscriminate atrocities he becomes a monster, which makes his ideas those of a monster, no matter how true. He crosses the line from revolutionary anarchist to terrorist-the worst thing a person can be.' Mangione's intentions to target the insurance industry were made clear by the writings, which prosecutors say prove that he committed first-degree murder in furtherance of terrorism, the Wednesday filing states. UnitedHealthcare became a symbol of the health insurance industry that Mangione aimed to abolish, prosecutors said. He was not insured by UnitedHealthcare from 2014 to 2024, prosecutors say, but at the time of his arrest, Mangione allegedly had a handwritten notebook that expressed 'hostility toward the health insurance industry and wealthy executives in particular,' according to a federal complaint. 'Having no business relationship with them, he chose UHC solely because they were the largest health insurance company and one of the country's largest companies by market cap,' the new filing said. Notably, three 9mm shell casings from the crime scene had the words 'delay,' 'deny' and 'depose' written on them, the NYPD has said, an apparent nod to a 2010 book critiquing insurance industry tactics. Mangione hoped the alleged killing would intimidate health insurance employees, cause the public to focus on greed in the health insurance industry and prevent investors and financial analysts from investing in the industry, according to the filing. The killing of the husband and father of two struck fear in C-suites across the country, as an NYPD intelligence report obtained by CNN warned online rhetoric could 'signal an elevated threat facing executives in the near-term.' Mangione inspired some individuals to partake in a 'broader campaign of threats of violence' against UnitedHealthcare employees and other health insurance workers, the document says. In the aftermath of Thompson's killing, threats had been aimed at other UnitedHealthcare executives and employees also reported feeling unsafe, prosecutors said. UnitedHealthcare doctors sending out denial letters to customers feared for their safety, requesting that they not be required to sign their names to the letters, prosecutors said. Some physicians quit their jobs out of fear of retribution. The company advised employees not to wear company branded clothes, and online threats prompted it to pull pictures of senior executives from its website, the filing states. Meanwhile, the company's call center received a slew of death threats, the filing said. 'You are gonna hang,' one caller said. 'That means that the killing of Brian Thompson was just a start. There are a lot more that are gonna be taken out. The only question is whether you're gonna be their collateral damage when its done or not.' Police were hired to protect the company's headquarters in Minnesota. Threats were also made to employees at the company's New York City office. Forty company executives received personal security, with one executive who received threats dying her hair and moving into another home out of fear for her safety, according to the filing. Other health insurance executives, including Emblem Health's CEO, were also targeted. Posters were put up outside the company's headquarters with the CEO's picture that read 'Health Care CEOs should not feel safe. Deny, Defend Depose.' The killing 'demonstrated his concerted effort to broadcast his message of ideological intimidation as broadly and loudly as possible,' prosecutors said. CNN's Kara Scannell, Zoe Sottile, Lauren del Valle and Michelle Watson contributed to this report.
