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Humira is a brand of adalimumab. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 1,248 of 5,492 Medicare Part D and Medicare Advantage drug plans (22.7%) list Humira on their formulary, across 92 of 286 formularies. The most common placement is tier 5 (1,177 plans, 94.3% of those covering it). 1,248 of the covering plans require prior authorization (100%), 0 step therapy and 1,131 a quantity limit.
16 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 16 of them $0; 1,232 charge coinsurance instead — median 27% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
2026: 2,901 of 5,496 plans covered it (52.8%); 2027: 1,248 of 5,492 (22.7%).
Of 4,367 plans offered in both years, 6 added it to the formulary and 1,381 dropped it.
Among plans covering it both years, 7 moved it to a higher tier and 3 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 31 |
| Tier 4 | 40 |
| Tier 5 | 1,177 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 24 of 323 | 7.4% | 100% |
| Medicare Advantage with drugs (MA-PD) | 744 of 3,200 | 23.3% | 100% |
| Special needs plans (SNP) | 480 of 1,969 | 24.4% | 100% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 0 of 830 | No tier listed | 0 |
| Devoted Health | 0 of 728 | No tier listed | 0 |
| Aetna Medicare | 631 of 631 | Tier 5 | 631 |
| Wellcare | 0 of 268 | No tier listed | 0 |
| HealthSpring | 0 of 226 | No tier listed | 0 |
| Kaiser Permanente | 0 of 112 | No tier listed | 0 |
| SCAN Health Plan | 83 of 83 | Tier 5 | 83 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 0 of 80 | No tier listed | 0 |
| Alignment Health Plan | 0 of 77 | No tier listed | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 5 | 74 |
| Wellpoint | 63 of 63 | Tier 5 | 63 |
| Priority Health Medicare | 0 of 40 | No tier listed | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 36 of 36 | Tier 5 | 36 |
| Capital Blue Cross | 0 of 35 | No tier listed | 0 |
| Prominence Health Plan | 0 of 29 | No tier listed | 0 |
| Medica | 0 of 27 | No tier listed | 0 |
| Anthem HealthKeepers | 26 of 26 | Tier 5 | 26 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 11 of 114 | 9.6% |
| Alaska | 1 of 9 | 11.1% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 38 of 147 | 25.9% |
| Arkansas | 22 of 85 | 25.9% |
| California | 166 of 397 | 41.8% |
| Colorado | 15 of 106 | 14.2% |
| Connecticut | 19 of 54 | 35.2% |
| Delaware | 6 of 43 | 14% |
| District of Columbia | 2 of 12 | 16.7% |
| Florida | 122 of 545 | 22.4% |
| Georgia | 25 of 149 | 16.8% |
| Guam | 0 of 1 | 0% |
| Hawaii | 6 of 50 | 12% |
| Idaho | 8 of 45 | 17.8% |
| Illinois | 28 of 132 | 21.2% |
| Indiana | 49 of 138 | 35.5% |
| Iowa | 15 of 64 | 23.4% |
| Kansas | 25 of 84 | 29.8% |
| Kentucky | 29 of 121 | 24% |
| Louisiana | 14 of 125 | 11.2% |
| Maine | 18 of 52 | 34.6% |
| Maryland | 16 of 49 | 32.7% |
| Massachusetts | 19 of 89 | 21.3% |
| Michigan | 28 of 182 | 15.4% |
| Minnesota | 10 of 63 | 15.9% |
| Mississippi | 19 of 104 | 18.3% |
| Missouri | 48 of 170 | 28.2% |
| Montana | 2 of 27 | 7.4% |
| Nebraska | 7 of 51 | 13.7% |
| Nevada | 32 of 100 | 32% |
| New Hampshire | 0 of 25 | 0% |
| New Jersey | 18 of 73 | 24.7% |
| New Mexico | 1 of 68 | 1.5% |
| New York | 83 of 215 | 38.6% |
| North Carolina | 23 of 176 | 13.1% |
| North Dakota | 3 of 26 | 11.5% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 51 of 171 | 29.8% |
| Oklahoma | 13 of 81 | 16% |
| Oregon | 16 of 92 | 17.4% |
| Pennsylvania | 38 of 323 | 11.8% |
| Puerto Rico | 0 of 64 | 0% |
| Rhode Island | 5 of 29 | 17.2% |
| South Carolina | 14 of 89 | 15.7% |
| South Dakota | 7 of 30 | 23.3% |
| Tennessee | 29 of 156 | 18.6% |
| Texas | 98 of 407 | 24.1% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 6 of 53 | 11.3% |
| Vermont | 2 of 14 | 14.3% |
| Virginia | 31 of 144 | 21.5% |
| Washington | 10 of 114 | 8.8% |
| West Virginia | 16 of 69 | 23.2% |
| Wisconsin | 12 of 96 | 12.5% |
| Wyoming | 0 of 13 | 0% |
Medicare Part D paid for 524,767 30-day fills of Humira in 2024 for about 63,749 enrollees, at an average total cost of $7,815.49 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Humira and the rest of a client's list on every plan in their county.
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.