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Medically reviewed by, Russell Braun RPH
What is Humira?
Humira (Adalimumab) was the top selling drug in the United States in 2018, producing 19.9 billion dollars in sales for AbbVie. It is an effective biologic drug, given by injection typically every other week. Autoimmune conditions such as the ones listed below are all potential uses for Humira.
- Rheumatoid arthritis
- Psoriatic arthritis
- Crohn’s disease
- Ulcerative colitis
- Plaque psoriasis
How much does Humira cost per month?
According to GoodRx, Humira costs $5150 per month if you were to pay cash. That large sum would get you two pens for injecting 40mg of Humira every other week.
Now that you have picked yourself back up off the floor lets discuss how you can lower that cost.
#1 Is there a generic?
Humira is different than most medications which have generic counterparts. Humira belongs to a class of drugs called biologics. The cells of microorganisms, humans or animals are programed to produce a biological drug. That biologic drug is usually a protein or other complex structure.
Due to the fact that Humira is created in this way and not by chemicals in a lab, there is no way to create an exact generic replica. Therefore, a generic swooping in as soon as the patent expires is not possible for Humira
Since you can’t easily reproduce an exact replica, the FDA has created a new class of products called biosimilars. Generic drugs are exact replicas of the original. An exact copay of the brand biologic drug is not possible with a biosimilar because it is made in a living cell.
Producing biosimilars is an intensive manufacturing process. For that reason the biosimilars themselves are also expensive. However, in Europe biosimilars to Humira recently became available and significant savings has been realized.
The FDA has approved three biosimilars to Humira:
- Amjevita (adalimumab – atto)
- Cyltezo (adalimumab – adbm)
- Hyrimoz (adalimumab – adaz)
A few points to clarify on biosimilars:
- All have their own brand names because they are not generics of Humira. True generic drugs do not have another brand name, they simply go by the generic name, in this case that would be adalimumab.
- The generic name of the biosimilar, since it is not an exact replica gets a four letter tag on the end. The FDA sets the tag and it is mandatory for all biosimilars. If you get a drug and see this on the label, you know it is a biosimilar.
When can I go pick up the biosimilar?
AbbVie the manufacturer of Humira is trying to protect its revenue stream. This is the top selling drug in the world! Therefore, Abbvie has been throwing there legal team at this trying to prevent biosimilars from taking market share.
They have been successful, creating new patent protection until September of 2023. Congress would need to take action to bring the high price tag down any sooner.
#3 Therapeutic alternatives
If you are being prescribed Humira, you have more than likely tried less expensive drugs called DMARD’s (Disease Modifying Antirheumatic Drugs). However, if you have not tried these drugs first you should talk to your doctor. They are much cheaper, if you are able to keep your condition in check.
Most of the diseases that Humira treats will end up progressing over time and require a biologic drug. Before you run and grab the Humira copay card, ask your doctor about other biologics that have biosimilars.
Remicade has a biosimilar that is a cheaper option. Also, Remicade is that it is administered by an infusion. You may be able to use your medical benefit for Remicade and that could save you money.
Depending on your insurance, you may have medical procedures covered 100% or you may have a deductible for your medical benefit, which you may have already met. You also likely have a pharmacy benefit to, that may have its own deductible, copay and coinsurance. Understanding how your benefits line up could save you money in the long run by choosing an alternative drug.
Another biologic drug that could be a therapeutic alternative to Humira is Enbrel. The biosimilar to Enbrel is Erelzi, which could be available in the U.S. in the near future.
In addition to therapeutic alternatives, there are some steps you can take in the course of your everyday lift to help curb your signs and symptoms of autoimmune diseases that Humira is used for. A great book on this topic is The Autoimmune Solution by Amy Myers.
#4 Patient Assistance Program
Manufacturers understand that most patients can’t afford drugs that run over $60,000 per year on an ongoing basis. Since Humira is a maintenance medication, you take in an ongoing basis, cost becomes an issue.
That is where pharmaceutical assistance programs come in. Keep in mind this is different than the copay card! This is where the manufacturer is covering the cost of the drug that the patient is responsible for. Your insurance is still footing the bill in this case.
You have to apply for this assistance and if you qualify, your prescription may be free. Always try these programs first as they are free, and given the amount of money you could save it is well worth the effort.
- Your doctor will have to submit this for you.
- Have to show proof of income.
- You must be uninsured, or proof your insurance did not cover the medication.
- You do not get this at the pharmacy, it is shipped to you or your doctor.
- Must apply again each year
- Website: www.abbvie.com/patients/patient-assistance.html
Having insurance when you have a condition that requires you to take Humira is going to be a huge benefit. The good news is that Humira has been proven to be effective for most of the conditions it is indicated for. That means that most insurance companies will cover Humira in some way.
Hoops to jump through
Insurers will require that your doctor complete a prior authorization in order for Humira to be covered, meaning they will pay for it. The prior authorization will require the doctor to complete questions the insurer wants to know do confirm the medication is being used properly.
They may want to know:
- The diagnosis.
- Other medications that have been tried. (aka step therapy)
- If you are allergic to other medications to treat your condition.
- Is the doctor is a specialist.
- Various other things.
#6 Does my insurance cover Humira?
According to the Humira website, 97% of commercial and Medicare part D plans will cover the drug. Humira has been proven effective in many clinical trials and has a relatively good side effect profile. That has earned it preferred status on most insurance plans formulary.
This does not mean you will be able to get the drug without some of the hoops listed above. You can check your insurance formulary status using this tool from the Humira website. Simply enter your state and then search for your insurance plan.
Prior authorization was denied?
In some cases the prior authorization may be denied. That does not mean it is the end of the road and you are responsible for the full cost. Your doctor can appeal the prior authorization denial.
This might take some time, but hopefully your doctor may be able to give you samples until the appeal is sorted out. In many cases PA’s get denied due to slow turnaround of information by your doctor or something was filled out incorrectly.
#7 What is the cost of Humira with Insurance?
This is a complicated question that will vary based on your insurance. The average copay range for a non-high deductible health plan is $100-$300 per month. If you do have a high deductible health plan then your out of pocket cost will vary depending on if you have met your deductible.
You might be thinking that the copay card makes it just $5, I will explain below why that can be deceiving.
A deductible is the amount of money set by your health insurance that you must pay out of pocket before your insurance starts to pay. You may have one deductible or separate ones. If they are separated one would be for medical costs (going to the hospital, office visits etc) and one for pharmacy costs.
High deductible health plans normally range from $1000-$7500 or more that you must pay each year before insurance kicks in. Once you meet the deductible you may have to pay a coinsurance, or a percentage of the bill typically around 15-20%. If you are lucky once you meet the deductible your plan could pay 100%
It is important to remember what your deductible is, even if you use a copay card. A new dirty trick in benefit design called copay accumulators could come back to haunt you!
A health savings account (HSA) is an account that you can save money in totally tax free for qualified medical expenses. They are normally paired up with high deductible health plans. Humira is an expense you can use your HSA to pay for. If you are on Humira and have a large out of pocket cost, you should definitely save money into an HSA to pay for the drug. It will make your earnings you have to pay out tax free!
If you have Medicare or any other form of government insurance you will NOT be able to use the Humira copay card. You should refer to the above section on the patient assistance program through AbbVie.
Medicare also offers the Extra Help subsidy, everyone on Medicare should check to see if they are eligible. Investigating this costs you nothing and if you are eligible the savings could be huge!
#8 Co-pay card
AbbVie offers a co-pay card for patients who are prescribed Humira. The card is like a coupon. It will not save your insurer any money off the price of the drug, but they save patients a large amount off of the copay they are responsible for.
This is how it works:
- A 30 day supply of Humira costs $5150
- The patient copay is $300
- Insurance pays $4850
- The co-pay for the patient is now $5
- AbbVie pays the pharmacy $295
Your insurance is still paying a large sum for the drug, which is why they make you jump through hoops previously mentioned. They don’t actually pay $4850, as there are rebates and middlemen involved, read Prescription for Maximum Savings to find out more on that.
Since AbbVie has a patient who will need ongoing therapy and they still stand to make a large amount off of the insurance each month, it is easy to see why they help pay for the co-pay of the patient.
To find out more visit the Humira co-pay card site. You can log in online to redeem your card whenever you need it. In addition, AbbVie is happy to send you a paper card like the one pictured below. They also send a kit containing an injection training information, medication reminder, sharps container and a travel case.
The manufacturer has a LOT of incentive to get you on and keep you on this drug. They will even have someone call you once you enroll in the co-pay card program.
Do co-pay cards work forever?
This is an important thing that most people don’t realize. At some point in 6 to 9 months or maybe 2 years your copay card will run out.
When you get to the point that the co-pay card runs out, you will be responsible for the full cost of the drug.
Think about it, you start Humira and it is working, your symptoms get better. Then boom, the co-pay assistance runs out and now you have to either pay $5150 per month or stop the medication because you can’t afford it.
This is the reason I lay out the steps to follow in this order with co-pay card last. For more on this topic check out my book Prescription for Maximum Savings.
#9 Patient Access Network Foundation (PAN)
The PAN foundation was developed by Pharma manufacturers. They are an independent non profit organization. PAN provides funds for patient to use toward out of pocket expenses for mediations.
Important differences from the co-pay card and patient assistance programs:
- Patient must have insurance that covers the medication
- Medicare Part D patients may be eligible for this assistance
- Must reside in U.S.
- Income limits between 400-500% of federal poverty level
- Patient is given a card that can be used at the pharmacy
- Must reapply for card every year
This is a creative way for Pharma companies to give assistance to patients who can’t use copay cards. This is a non-profit set up by multiple Pharma companies and not just one, which is how they get around the co-pay card rules. This allows patients on government insurance, such as Medicare and Medicaid to be able to receive assistance.
AbbVie has also set up a program if you can’t use their co-pay card for some reason. It is called the Humira complete prescription rebate.
What is Humira complete?
For most patients who have insurance coverage, Humira complete will allow them to receive rebates. Patients need to collect receipts from Humira out of pocket expenses and long into the portal at CompleteRebate.com. Then, upload your receipts into the portal.
Eligibility is determined on a case by case basis. If you qualify you will receive a rebate check in the mail. Another option is to call 1.800.4Humira.
#11 Copay accumulators
More and more specialty medications have come on the market in recent years. Like Humira they have very high prices. In my example above I explain that even with a co-pay coupon the health insurance plan is still paying a large sum for these drugs.
In an effort to curb spending on these medications, insurance benefits have been altered in recent years to try to claw back the money that patients were supposed to be paying in order to meet their deductibles.
This gave rise to copay accumulators. What is that you ask?
It is just a fancy way to to say that they are going to calculate how much you actually paid out of the copay. Then the amount you paid is the only part that will apply toward your deductible. When the co-pay card assistance runs out, you will be stuck with your full deductible left to pay.
Patient deductible is $1500
|Fill 1||Fill 2||Fill 3||Fill 4||Fill 5||Fill 6|
|Insurer $4850||Insurer $4850||Insurer $4850||Insurer $4850||Insurer $4850||Insurer $4850|
|AbbVie $295||AbbVie $295||AbbVie $295||AbbVie $295||AbbVie $295||AbbVie $295|
|Patient $5||Patient $5||Patient $5||Patient $5||Patient $5||Patient $5|
As you can see from the table, over the 6 months the patient has only paid $30. Copay accumulators say instead of $1800 being applied toward the deductible ($300 x 6 months) only $30 would be.
If the copay card were to run out after 6 months, then the patient would be faced in month 7 with a $1470 bill ($1500 deductible – $30 actually paid by patient over previous 6 months).
Watch out for copay accumulators, especially if you use a Humira co-pay card!
Eat right to prevent symptoms
In addition to saving money on Humira, the Anti-Inflammatory Diet cookbook will show you how to cook in a autoimmune friendly way. If you fuel your body consistently with food likely to lower inflammation it could result in less trips to the doctor and less medication.
Share your story
Have you used Humira? Did the co-pay card work for you? Please chime in below with your comments and thoughts.
Tune into my blog BestRxForSavings for more tips and actionable advice on how to save money and only take medication you really need.