Does Aetna cover Humira?

In this article:

• Does Aetna cover Humira?
• How much does Humira cost with Aetna?
• How much does Humira cost without insurance?
• How to check whether your Aetna plan covers Humira
• What alternatives are there if Humira is not covered by my insurance?
• How can I save money on Humira?

In this article

• Does Aetna cover Humira?
• How much does Humira cost with Aetna?
• How much does Humira cost without insurance?
• How to check whether your Aetna plan covers Humira
• What alternatives are there if Humira is not covered by my insurance?
• How can I save money on Humira?

If you are living with an autoimmune condition, your healthcare provider may prescribe Humira (adalimumab). This prescription medication, manufactured by AbbVie, Inc., is approved by the Food and Drug Administration (FDA) to treat conditions such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, ankylosing spondylitis, uveitis, and juvenile idiopathic arthritis (JIA).  

Humira is a biologic drug that’s in a drug class called tumor necrosis factor (TNF) inhibitors. TNF inhibitors reduce the signs and symptoms of excessive inflammation caused by the TNF protein in certain autoimmune conditions. As a complex biologic drug, it is very expensive to make, and that cost is passed down to consumers. There are several biosimilar versions available, which may be more affordable options than brand-name versions. Most people rely on health insurance, Medicare, or Medicaid to help pay for Humira. 

Does Aetna cover Humira?

​​As of April 1, 2024, most Aetna formularies no longer cover Humira. With the recent changes, members will have access to a selection of biosimilar adalimumab products that are lower cost alternatives, such as Cyltezo (adalimumab-adbm), Yusimry (adalimumab-aqvh), and Hulio (adalimumab-fkjp). Some healthcare providers may recommend completely different alternatives, depending on the condition being treated. 

“Methotrexate is our first-line treatment for rheumatoid arthritis,” says Francesca Okoye, MD, a board-certified rheumatologist with Rheumatology at Mercy Medical Center in Baltimore, Maryland. “I prescribe Humira for patients who have failed to improve on methotrexate or who have not tolerated it. Or I would prescribe Humira for people who have other medical conditions and who cannot take methotrexate.”

Insurance coverage can be complicated and every health plan is different. 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.

In many instances, prior authorization may be required for certain medications. This is when a healthcare provider coordinates with the insurance company to ensure that a prescribed medicine or treatment is medically necessary.

How much does Humira cost with Aetna?

If you have an Aetna insurance plan, what you pay out of pocket for your prescription will depend on the specifics of your plan. Since Humira is a specialty drug, it is likely to be on the highest drug tier, meaning the most expensive copay. 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, according to its manufacturer, AbbVie. However, some Aetna Medicare plans may completely cover the medication. 

How much does Humira cost without insurance?

Humira costs vary by pharmacy, but without insurance or discounts, you can expect to pay the average retail price of $9,283 for one kit that includes two subcutaneous autoinjectors, which is a one-month supply. This drug’s high cost is due to its complex production process and use of DNA technology.  

How to check whether your Aetna plan covers Humira

There are a number of ways to find out if your Humira will be covered by Aetna:

• Call Aetna directly and ask to be connected with someone who could provide detailed information about coverage for Humira. Check whether your member ID card has a phone number for pharmacy benefits.
• Try logging into your Aetna account online. You may be able to search for certain medications like Humira to see if your specific plan covers it and, if it does, how much it will cost.
• Your pharmacist may also be able to help determine whether your plan covers Humira. They should have access to the details of your healthcare plan and could verify insurance coverage.

What alternatives are there if Humira is not covered by my insurance?

“Your insurance company may pay for a drug that is a biosimilar to Humira,” Dr. Okoye says. A biosimilar is similar to a generic but made to be very similar to a biologic drug. Various biosimilars have been FDA approved for Humira:  

• Amjevita (adalimumab-atto)
• Cyltezo (adalimumab-adbm)
• Hyrimoz (adalimumab-adaz)
• Hadlima (adalimumab-bwwd)
• Abrilada (adalimumab-afzb)
• Hulio (adalimumab-fkjp)
• Yusimry (adalimumab-aqvh)
• Idacio (adalimumab-aacf)
• Yuflyma (adalimumab-aaty)
• Simlandi (adalimumab-ryvk)

“In addition to Humira biosimilars, there are four other TNF-alpha inhibitors that may be covered by insurance,” Dr. Okoye says. These include Enbrel (etanercept), Cimzia (certolizumab pegol), Simponi (golimumab), and Remicade (infliximab).

RELATED: Humira alternatives

How can I save money on Humira?

There are several ways to save on Humira. For example, a SingleCare prescription discount card provides access to Humira coupons you can use at over 35,000 participating pharmacies across the country. With a Humira coupon from SingleCare, you could save over $3,000 for Humira.

Medication can be expensive even if insurance covers it. If you have commercial or private health insurance from Aetna, you may be eligible for the Humira copay card, which can reduce your prescription to as little as $0 per month. Aetna’s Medicare prescription drug plans are ineligible for the copay card, however.

You can also talk to your healthcare provider or pharmacist, who may be aware of other ways to reduce your costs.