Stable on Humira? You have the right to request continued coverage.

Fight Your Humira Formulary Removal

Some major PBMs removed Humira, but you can appeal for continuity of care.

Understanding Your Humira (Adalimumab) Continuity of Care Denial

CVS Caremark, Express Scripts, and other major pharmacy benefit managers have removed Humira from many formularies in favor of biosimilars. If you've been stable on Humira and your insurer wants you to switch, you have rights under federal continuity of care regulations and potentially state non-medical switching laws.

Common Reasons for Denial

! Humira removed from formulary — biosimilar required
! Plan requires switch to preferred biosimilar (Hyrimoz, Hadlima, etc.)
! Humira no longer covered at current tier
! Prior authorization required for continued Humira use
! Non-formulary exception denied

How We Help

We help you document your treatment history with Humira, explain why biosimilar switching may be harmful in your case, and cite federal and state laws that protect stable patients from forced medication changes.

Start your Humira continuity of care appeal.

Some Types of Evidence We Can Use For Supporting Your Appeal

✓ many health plans must provide a transition process when drugs are removed from formulary, and patients can request exceptions based on medical necessity.

✓ The FDA requires that biosimilars demonstrate no clinically meaningful differences from the reference product, but individual patient responses may vary.

✓ Studies on biosimilar switching show mixed results, and some patients may experience changes in efficacy or tolerability when switching from a reference biologic.

Pharmacy Discount Options

Humira is usually expensive even with discount cards, so the appeal is your primary path to coverage. Discount programs below may still reduce the cost somewhat, but check the price before assuming they make the drug affordable.

GoodRx (opens in a new tab)

Free discount card accepted at most US pharmacies. Compare prices across nearby pharmacies and present the GoodRx coupon at the counter.

Mark Cuban Cost Plus Drugs (opens in a new tab)

Mail-order pharmacy with transparent pricing (manufacturer cost + 15% markup + dispensing fee). Carries many common generics.

Amazon Search (opens in a new tab)

Search Amazon's main retail site for over-the-counter formulations or supplies related to this medication. (This is Amazon's general product search, not the prescription Amazon Pharmacy storefront; Prime members may see discounted prices.)

Important: amounts paid out-of-pocket through discount programs typically do NOT count toward your insurance deductible or out-of-pocket maximum. Continue your appeal to get the medication covered through insurance.

Financial Assistance Directory

Curated copay foundations, manufacturer programs, and safety-net clinics that may help with the cost while you appeal.

Manufacturer copay programs

Humira Complete Savings Card (AbbVie) (opens in a new tab)

Copay card for commercially-insured Humira patients - may bring copay to as little as $5/month for eligible plans.

Eligibility: Commercial insurance only.

General copay foundations & directories

NeedyMeds (opens in a new tab)

Searchable database of 5,000+ patient assistance, copay, and diagnosis-specific programs. Start here if you are not sure where to look.

Eligibility: No eligibility check - the directory itself is free. Individual programs have their own income and insurance criteria.

Patient Advocate Foundation Co-Pay Relief (opens in a new tab)

Direct copay assistance for insured patients with chronic, life-threatening, or rare conditions. Covers many disease funds.

Eligibility: Generally requires insurance coverage and income up to 400% of the federal poverty level (varies by fund).

Phone: 1-866-512-3861

HealthWell Foundation (opens in a new tab)

Independent charity providing copay, premium, and travel assistance grants across 70+ disease funds.

Eligibility: Must have insurance covering the prescribed treatment; income thresholds vary by fund. Funds open and close as donations allow.

The Assistance Fund (TAF) (opens in a new tab)

Copay, insurance premium, and travel assistance for patients with chronic and rare diseases.

Eligibility: Must have insurance and meet income limits (typically up to 500% FPL, fund-dependent).

Good Days (opens in a new tab)

Copay assistance and other support for chronic-disease patients.

Eligibility: Funds vary by disease and open/close based on availability. Usually requires insurance and income under ~500% FPL.

PAN Foundation (Patient Access Network) (opens in a new tab)

Disease-specific copay assistance funds for ~70 conditions. Funds open and close throughout the year - check the website or sign up for fund-open alerts.

Eligibility: Insurance required; income limits typically 400-500% of FPL depending on the fund.

NORD (National Organization for Rare Disorders) (opens in a new tab)

Patient assistance, copay, and travel programs for people living with rare diseases.

RxAssist Patient Assistance Program Center (opens in a new tab)

Comprehensive directory of manufacturer patient assistance programs. Search by medication to find the manufacturer's free-drug program if you are uninsured or under-insured.

Safety-net clinics & 340B

HRSA Find a Health Center (FQHC locator) (opens in a new tab)

Federally Qualified Health Centers (FQHCs) provide primary care on a sliding-fee scale and dispense many medications at 340B-discounted prices, regardless of insurance status. Often the cheapest path for uninsured or under-insured patients.

HRSA 340B Program (provider directory + program info) (opens in a new tab)

Background on the 340B Drug Pricing Program. Use to verify whether a particular clinic or hospital is a covered entity before assuming discounted pricing applies.

State Pharmaceutical Assistance Program (SPAP) directory (opens in a new tab)

State-run programs (mostly for seniors and people with disabilities) that supplement Medicare Part D and reduce prescription costs. Availability and benefits vary by state.

Medicaid eligibility & application (Healthcare.gov) (opens in a new tab)

If denied insurance is unaffordable, check Medicaid / CHIP eligibility - thresholds and pathways vary by state, and many expansion states cover adults up to 138% FPL.

Program eligibility, fund availability, and contact info change frequently. Verify with each organization before assuming a program is open.

Patient Assistance & Copay Programs

These programs may help reduce your costs while you appeal:

HUMIRA Complete Savings Card

Pay as little as $5 per month with commercial insurance. Not valid with government insurance.

myAbbVie Assist

Patient assistance for uninsured or underinsured patients who qualify based on income.

Eligibility requirements and program terms may change. Please verify current details directly with each organization.

Patient Advocacy & Support Organizations

These organizations provide education, support, and advocacy for patients:

Arthritis Foundation

Leading organization for arthritis advocacy and support.

Crohn's & Colitis Foundation

IBD patient advocacy and support organization.

Frequently Asked Questions

Multiple adalimumab biosimilars have entered the market since 2023, and PBMs have negotiated deals to prefer certain biosimilars. CVS Caremark, Express Scripts, and OptumRx all excluded Humira from many formularies for 2025 in favor of lower-cost biosimilar options.

Biosimilars are highly similar but not identical to the reference product. While FDA-approved biosimilars are considered safe and effective, some patients experience different responses when switching. Your appeal can document any concerns about switching.

Document your experience with the biosimilar — side effects, efficacy issues, or other problems. This strengthens your case for continued Humira coverage as medically necessary.

Yes. Depending on your plan and it's regulator you can request a non-formulary exception based on medical necessity. Your doctor should provide a letter explaining why Humira specifically is needed for your care.

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Disclaimer: Fight Health Insurance is not affiliated with, endorsed by, or partnered with any pharmaceutical manufacturer, healthcare provider, medical device company, or patient assistance program. All information provided is for educational and informational purposes only and does not constitute medical or legal advice. Please consult with your healthcare provider regarding treatment options and with your insurance company regarding coverage decisions.