Does Medicare Part D cover Humira?
Coverage, cost, and 2026 details for Humira (adalimumab) under Medicare Part D.
Quick answer: Yes, Humira is generally covered by Medicare Part D plans, typically on Tier 5 (specialty). Coverage details, copays, and restrictions vary by plan, so compare plans available in your area to find the best coverage for your medications.
What is Humira?
Humira (adalimumab) is a biologic medication used to treat several autoimmune conditions including rheumatoid arthritis, Crohn's disease, plaque psoriasis, ankylosing spondylitis, and ulcerative colitis. It's typically self-injected at home every two weeks. Several biosimilar versions are now available, often at lower cost.
Is Humira covered by Medicare Part D?
Humira is covered by most Medicare Part D plans on Tier 5 (specialty), which has higher coinsurance. Multiple biosimilars (Amjevita, Cyltezo, Hyrimoz, Hadlima, and others) are now FDA-approved and many Part D plans now prefer biosimilars over brand-name Humira. The $2,100 annual cap limits your maximum out-of-pocket cost regardless of tier.
Typical formulary tier
Humira is most often listed on Tier 5 (specialty) of Part D formularies. The exact tier — and the copay — depends on the specific plan you're enrolled in.
How much does Humira cost with Medicare Part D?
Without insurance, Humira costs around $7,000 per month for brand at retail pharmacies. With Medicare Part D coverage, you typically pay Variable; the $2,100 annual cap limits your total out-of-pocket cost. Most Humira and biosimilar users hit the cap with their first or second fill..
Your actual cost depends on:
- Your plan's deductible — up to $615 in 2026
- The tier Humira is on in your plan's formulary
- Whether you've reached the $2,100 annual out-of-pocket cap
- Whether you qualify for Extra Help (Low-Income Subsidy)
- Whether you've enrolled in the Medicare Prescription Payment Plan (M3P), which spreads costs across the year
How to lower your Humira costs
1. Compare Part D plans for your specific drugs
The same drug can cost dramatically different amounts on different plans. During the Annual Enrollment Period (October 15 – December 7), use the Medicare.gov Plan Finder to compare what Humira would cost across every plan available in your ZIP code.
2. Check if you qualify for Extra Help
If your income is below approximately $23,475 (single) or $31,725 (married couple) in 2026, you likely qualify for Extra Help, which dramatically reduces what you pay for Humira and all your medications. Learn about Extra Help →
3. Use the Medicare Prescription Payment Plan (M3P)
M3P doesn't lower your total cost, but it spreads your annual out-of-pocket costs into monthly installments — which can help if Humira causes a big upfront pharmacy bill. Learn about M3P →
4. Look into Patient Assistance Programs
AbbVie may offer a Patient Assistance Program for people with limited income who don't qualify for Extra Help. These programs can provide free or deeply discounted medication directly from the manufacturer. Learn more about manufacturer programs →
5. Ask about alternatives
Talk to your doctor about whether a different medication — including a generic version or a similar drug in the same class — would work for you.
Alternatives to Humira
Other medications used for rheumatoid arthritis, Crohn's disease, psoriasis, ankylosing spondylitis, ulcerative colitis, and other autoimmune conditions include:
- Biosimilar adalimumab (Amjevita, Cyltezo, Hyrimoz, Hadlima)
- Enbrel (etanercept)
- Cimzia (certolizumab)
- Simponi (golimumab)
- Other targeted therapies depending on condition
Always discuss any medication change with your prescribing doctor.
Key facts about Humira on Medicare
- Multiple biosimilars now available at lower cost
- Subject to the $2,100 Part D out-of-pocket cap
- Typically Tier 5 (specialty) tier
Frequently asked questions about Humira on Medicare
Does Medicare cover Humira?
Yes, Humira is generally covered by Medicare Part D plans, most often on Tier 5 (specialty). Coverage and costs vary between plans, so compare plans available in your area. Some plans require prior authorization.
How much does Humira cost on Medicare Part D?
Costs typically range from Variable; the $2,100 annual cap limits your total out-of-pocket cost. Most Humira and biosimilar users hit the cap with their first or second fill.. Your actual cost depends on your plan's deductible, the tier Humira is on, and whether you've reached the $2,100 annual out-of-pocket cap.
Is there a generic version of Humira?
Yes — generic versions are available and significantly cheaper. Most Part D plans cover the generic on a lower tier with lower copays.
What if my Part D plan doesn't cover this drug?
You have several options: (1) Switch to a different Part D plan during Annual Enrollment that covers Humira, (2) Request a formulary exception from your current plan with your prescriber's support, (3) Ask your doctor about a covered alternative medication, or (4) Look into the manufacturer's Patient Assistance Program if you have limited income.
Compare your Part D options
Coverage and costs for this drug vary significantly between plans. Compare your options:
You can also visit Medicare.gov or call 1-800-MEDICARE