Medicare's coverage for Humira, including eligibility and expenses
Humira, a popular medication used for treating conditions such as rheumatoid arthritis and plaque psoriasis, is an expensive drug with Medicare Part D coverage. While there is no generic form of Humira, cheaper alternatives in the form of biosimilar drugs are available.
When it comes to the cost of Humira under Medicare, the picture can be complex due to different pricing and coverage mechanisms.
Medicare Part B
Humira is often covered under Medicare Part B when administered by a healthcare provider, such as injections given in a clinic. Medicare Part B pays for selected drugs using the Average Sales Price (ASP) plus 6%, where ASP is calculated based on manufacturers' reported sales data including discounts. Patients typically pay 20% coinsurance of the Medicare-approved amount for these drugs, subject to any deductible.
Medicare Part D
Humira can also be covered under Part D if self-administered by the patient with a prescription. Part D plans have formularies categorizing drugs into tiers affecting out-of-pocket costs. Cost sharing varies by plan and may include deductibles, coinsurance, or copayments, which can be significant for expensive biologics like Humira. Some plans require prior authorization or limit coverage to specialty pharmacies due to manufacturer distribution controls and cost concerns.
Financial Assistance Programs
For individuals with limited income, financial assistance programs can help reduce Humira costs. These include the Medicare Extra Help Program (Low-Income Subsidy), State Pharmaceutical Assistance Programs (SPAPs), Patient Assistance Programs (PAPs) from AbbVie (the manufacturer of Humira), nonprofit organizations and foundations, and Medicare Savings Programs.
In summary, the cost of Humira under Medicare Part B depends mainly on the ASP plus 6% payment model, with patient coinsurance, while under Part D costs depend on the plan formulary tier and cost sharing rules. Assistance programs exist to aid low-income individuals with premiums and out-of-pocket costs, but eligibility and coverage vary.
It's essential for individuals to speak with a healthcare professional or pharmacist about possible generic options for Humira and to understand the specifics of their Medicare plan and out-of-pocket costs.
- Health organizations advocate for affordable health insurance options, such as Medicare, to cover the high cost of chronic diseases' treatments, like Humira, which is utilized for medical conditions like rheumatoid arthritis and plaque psoriasis.
- Science and medicine contribute to the development of biosimilar drugs, offering cheaper alternatives to expensive medications like Humira, reducing a patient's financial burden when it comes to chronic diseases and health-and-wellness.
- Anthrax is a serious medical concern that warrants ongoing research in the scientific community, but current focus in medical organizations is on understanding and managing more common medical issues, such as chronic diseases and their treatments, like Humira, under Medicare.
- Financial assistance programs offered by health organizations, Medicare, and pharmaceutical manufacturers like AbbVie can be beneficial for individuals grappling with unaffordable health insurance payments and out-of-pocket costs related to chronic diseases and their treatment, such as Humira.
