Humira

Generic: adalimumab

40MG/0.4ML, 40MG/0.8ML, 80MG/0.8ML — Auto-Injector

ANALGESICS - ANTI-INFLAMMATORY

Also known as: HUMIRA PEN AJKT 40MG/0.4ML, 40MG/0.8ML, 80MG/0.8ML HUMIRA PEN KIT PS/UV adalimumab Humira Pen Humira Pen-Cd/Uc/Hs Start Humira Pen-Ps/Uv Starter Humira 40 Mg/0.8 Ml Pen Humira 40 Mg/0.8 Ml Syringe HUMIRA PEN AJKT 40MG/0.4ML,
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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Jan 1, 2026  ·  Checked: 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Standard Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Clear Silver with $0 Insulin Options Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Focused Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Expanded Bronze with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Silver with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Standard Gold with Atrium Health Tier 5 - Specialty ✓ — ✓ PA | QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Complete Gold + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Everyday Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Elite Bronze + Vision + Adult Dental Tier 5 - Specialty ✓ — ✓ PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026 Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
BCBSNC Blue Care 2026 Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
BCBSNC Blue Value 2026 Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
BCBSNC Blue Advantage 2026 Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026 Tier 5 - Specialty ✓ — ✓ Restricted Access PA | QL
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026 Tier 4 - Specialty ✓ — ✓ Specialty Pharmacy Required PA | QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 6 per 28 days PA | QL
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 6 per 28 days PA | QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 6 per 28 days PA | QL
HealthTeam Advantage Plan II (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HealthTeam Advantage Vitality Plan (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HealthTeam Advantage Plan I (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Aetna Medicare Signature (HMO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Dual (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Signature (HMO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Value Plus (HMO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Prime (HMO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Signature Care (HMO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Enhanced (HMO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Enhanced (PPO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Enhanced (PPO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Signature Extra (PPO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Signature Giveback (PPO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Chronic Care (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 26 per 365 days PA | QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED CORE 001 NC (HMO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED GIVEBACK 002 NC (HMO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED GIVEBACK 012 NC (HMO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED CHOICE 001 NC (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED CHOICE 003 NC (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED CHOICE 005 NC (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED CHOICE 008 NC (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus H6622-057 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus H6622-060 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus H6622-061 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Choice H8145-004 (PFFS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus H1036-233 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Dual Select H1036-307 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus H1036-335 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HumanaChoice Giveback H5216-017 (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HumanaChoice H5216-211 (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Full Access H5525-034 (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HumanaChoice Giveback H5525-035 (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HumanaChoice H5525-049 (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HumanaChoice H5525-050 (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HumanaChoice H5525-070 (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Dual Select H5525-072 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
HumanaChoice H5525-083 (PPO) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus H6622-025 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Gold Plus H6622-026 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 6 per 28 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026 Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026
via adalimumab 		Tier 1 - Basic Core Formulary ✓ — — PA
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