Humira, a brand name for the drug Adalimumab, is a biological medication that you can self-administer by subcutaneous injection. It provides relief from pain and swelling that commonly accompany many autoimmune conditions like rheumatoid arthritis, Crohn’s disease, or chronic plaque psoriasis.
Although Humira is the highest selling drug in the world today, it may not be right for you. You should sit down with your health care provider and discuss all the details concerning your condition and options before making your decision. Humira is not cheap, so if your physician prescribes it for you, you need to have information about your Medicare coverage.
What is Humira?
Humira is a biologic drug produced from protein antibodies that have been taken from a living organism. Doctors may prescribe it as a treatment for a variety of autoimmune conditions.
People living with autoimmune diseases such as rheumatoid arthritis, may be familiar with the term tumor necrosis factor (TNF). This is a protein in the human body that causes inflammation. If your immune system is working properly, TNF levels are normal. But in cases of autoimmune disease, there is an overproduction of TNF or TNF (alpha), which causes severe inflammation and pain as a result.
Humira works by inhibiting this over-production of TNF (alpha) in the body and therefore reducing inflammation and pain. It can be self-administered in the thigh or abdomen. Humira comes in a prefilled, single-dose pen and is usually taken every 2 weeks.
For what conditions is Humira treatment helpful? Doctors may prescribe Humira to treat people who have moderate to severe forms of the following conditions:
- Rheumatoid arthritis
- Plaque psoriasis
- Crohn’s disease
- Ulcerative colitis
- Psoriatic arthritis
- Hidradenitis Suppurativa
- Ankylosing Spondylitis
Medicare Coverage of Humira
Medicare beneficiaries may have coverage for Humira if they have enrolled in Medicare prescription drug coverage (Medicare Part D), and if the plan includes Humira in its formulary. A formulary is the list of prescription drugs that the plan covers.
Medicare Part D plan is voluntary coverage that you can purchase from a private insurance company. With Medicare Part D, you have prescription drug coverage that is independent of your Original Medicare Part A or Part B insurance. You also get prescription drug coverage if you enroll in a Medicare Advantage (Part C) plan that includes drug coverage.
If you don’t already have prescription drug coverage, you can select and sign up for a Medicare Part D plan that is available where you live. Every state or region of the U.S. has between 40 and 50 different Medicare Prescription Drug Plans available to choose from. When selecting the best prescription drug program for your needs you should find out what drugs the plan covers, what the monthly premiums are, and which pharmacies work with your plan.
As Medicare beneficiaries, you may be able to save a lot of money if your Medicare prescription drug plan covers Humira. One subcutaneous kit containing 2 doses of 10 mg (0.1 ml) each of Humira costs approximately $5,410.00. That means you will have to pay around $1800.00 to $2400.00 per month for the drug if you don’t have a Medicare Prescription Drug Plan (PDP) or a Medicare Advantage plan with prescription drug coverage (MA-PD).
With coverage, your final cost depends on your individual plan’s benefits. Your health insurance provider will give you all the details about your final costs. If you have been living with the pain and inflammation of an autoimmune disease, Humira may help you get relief. Your physician is the most qualified person to fill you in on all the facts about this medication and to help you decide if it is right for you.