23-05-2025
Does Medicare Cover Humira?
Key takeaways
Medicare typically covers Humira through Part D when self-administered or Part B when administered by a doctor.
As of 2025, Medicare beneficiaries won't have to pay more than $2,000 out-of-pocket on drugs before Part D coverage kicks in.
Various assistance programs, including Medicare Extra Help, Medicaid, PACE, and pharmaceutical assistance programs, are available to lower Humira costs.
Humira (adalimumab) is a biologic medication used to treat inflammatory conditions by targeting and blocking TNF-alpha, a protein involved in inflammation. Many of these conditions are chronic, which means they need continued treatment for lifelong management.
Medicare typically covers Humira through Part D and Part C. But since Humira is considered a specialty drug, it can be expensive, though many factors play into the cost you'll pay.
You may be able to get help paying for the cost of Humira in several ways. Keep reading to learn more about Humira, what parts of Medicare cover it, and how much it may cost you.
Can I get Humira on Medicare?
Whether or not Medicare covers Humira may depend on how you are taking the drug. Since Humira is an injection, it may be covered through Medicare Part D, Medicare's prescription drug coverage, if you can administer it to yourself at home.
If you are not able to administer it yourself at least 50% of the time, Part D may not provide coverage. However, in this case, Medicare Part B may cover Humira if your doctor administers the medication in an outpatient setting.
Part D plans are sold by private insurance companies and can be added to your Original Medicare coverage. In order to determine if your specific plan covers Humira, you'll need to check the formulary, which is a list of all the prescription drugs the plan covers.
Formularies often include at least two medications for each drug class. If you take Humira, you can find out which plans cover it by comparing different Part D plans.
Additionally, the formulary often divides the covered prescription drugs into different tiers. Those listed in higher tiers (tiers 3 to 5) typically cost more than those in lower tiers (tiers 1 and 2).
What if I have Medicare Advantage?
Medicare Part C is also called Medicare Advantage. Part C plans are sold by private insurance companies, and you can enroll in one as an alternative to Original Medicare.
The cost of a Part C plan can vary based on your location. Part D prescription drug coverage is included in most Part C plans. If you want prescription drug coverage with your Part C plan, you'll have to include that coverage when you shop for a plan.
You can't enroll in a separate Part D plan if you have Medicare Advantage. As with Part D, it's important to review a Part C plan's formulary to see if the medications you take are listed there. If you have additional questions or concerns, contact your pharmacy or the plan's company directly.
Can a Medigap plan help with my costs?
Medigap is a form of supplemental insurance sold by private insurance companies. A Medigap plan can help pay for costs that original Medicare (parts A and B) doesn't cover, such as copays.
These plans can't be used with Part C (Medicare Advantage). You must choose one or the other.
Prior to 2006, some Medigap plans offered coverage to help with prescription drug costs. However, Medigap plans are no longer permitted to offer this coverage. Though these plans have been discontinued, you can usually keep your plan if you're already enrolled in one.
How much does Humira cost?
Since Humira is a specialty drug, it can be expensive. You may find that Humira is listed in the higher tiers of a plan's formulary.
A 2019 study looked at the total cost of Humira by combining the amount that insurance companies paid plus the out-of-pocket costs paid by their beneficiaries. The study found that the median cost of Humira per month was $4,338 in 2017.
The costs of Humira under Medicare can depend on where you are in your prescription drug coverage. Let's take a closer look at the costs at each threshold of coverage:
Deductible: Each Part D plan has a yearly deductible. For 2025, this cost cannot exceed $590 for any plan. You must pay the deductible out of pocket before your plan will begin to cover your Humira prescription.
Coverage: Once you meet your deductible, you pay a copayment or coinsurance when you fill your Humira prescription. The exact amount depends on your specific plan.
Spending cap: As of 2025, you won't have to pay more than $2,000 out-of-pocket on drugs before Part D coverage will kick in.
A study from early 2020 used data from formularies and pricing files to estimate the yearly out-of-pocket costs for Humira under a Part D plan. These projections indicated that, depending on the dose, Humira could cost an individual between $5,168 and $5,196 in 2019. However, the costs in 2024 are likely a bit higher.
How can I get more help to cover my prescription drug costs?
If you're concerned about the costs of Humira, you can get help in several ways:
Medicare Extra Help
Medicare Extra Help is a program that assists people who have limited income or resources with paying for prescription drugs. With Extra Help, you pay no more than $12.15 for brand-name drugs like Humira.
If you already have Medicaid, Social Security insurance, or a Medicare savings plan, you'll automatically qualify for Extra Help. Otherwise, you can apply for Extra Help through the Social Security Administration website, as long as you meet certain income limits.
Medicaid
Medicaid is a federal and state program that helps pay for healthcare for those with lower incomes. While eligibility and benefits can vary by state, Medicaid programs in some states may help with the cost of prescription drugs.
You can use the Medicaid website to find information on your state's Medicaid office.
PACE
Programs of All-Inclusive Care for the Elderly (PACE) is available through Medicare and Medicaid and can help you find care while living at home in your community.
One of the benefits that may be covered by PACE is prescription drugs.
You can use Medicare's search tool to see if there's a PACE program in your area. For additional information, you can also contact your state's Medicaid office.
Pharmaceutical assistance programs
Pharmaceutical assistance programs are available through drug manufacturers and other foundations to help you pay for specific medications. To check on pharmaceutical assistance programs for Humira, you can use this Medicare search tool.
Additionally, some states may have their own pharmaceutical assistance programs. You can search here to see if your state has one.
Pharmacy discount companies
Some pharmacy discount companies may offer coupons for Humira. Other companies you can try include GoodRx and SingleCare.
Frequently asked questions
Does Medicare pay for other biologic injections?
Part B may pay for biological injections administered by a healthcare worker at a hospital or clinic. Like with Humira, if you self-administer the drug, Part D may cover it depending on your specific plan and its formulary.
What is the cost per month for Humira?
A 40-milligram (mg) syringe of Humira now costs about $2,984, or about $77,586 annually, according to the Committee on Oversight and Reform in the U.S. House.
The takeaway
Medicare typically covers Humira. This coverage is often provided by Medicare Part D or Part C plans.
Each insurance company chooses the prescription drugs it covers and lists them in a formulary. Because of this, it's important to check a specific plan's formulary to make sure that Humira is included.
While the cost of Humira can potentially be high, numerous programs like Medicare Extra Help and pharmaceutical assistance programs can help lower your costs.
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