HUMIRA(CF)

80MG — Pen Injector

Also known as: HUMIRA(CF) PEN CRHN-UC-HS HUMIRA(CF) PEN PS-UV-AHS
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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: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 5 hours, 27 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Connect Bronze 6500 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Bronze 5500 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Silver 4400 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Silver 3500 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Silver 3000 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Bronze CMS Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Silver CMS Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Gold CMS Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Connect myDiabetesCare Bronze Tier 5 - Specialty ✓ — ✓ PA | QL
Connect myDiabetesCare Silver Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Gold 1500 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Bronze RD 5000 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Bronze RD 6000 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Bronze RD CMS Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Silver RD 3500 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Silver RD 5000 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Silver RD CMS Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Silver RD 2200 Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Gold RD CMS Standard Tier 5 - Specialty ✓ — ✓ PA | QL
Connect Bronze 7000 HSA Indiv Med Deductible Tier 5 - Specialty ✓ — ✓ PA | QL
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