Priority Health: Humira Coverage Ending — Replaced with Biosimilars for Commercial Members effective Dec. 31, 2023

October 9, 2023

To maintain our commitment to providing our members with the most effective therapies at the lowest possible cost, Humira coverage will end for our commercial group and individual members on Dec. 31, 2023. This includes both new-start and existing prescriptions.

Humira will remain on the Medicare formulary, with prior authorization requirements, through 2024.

Effective Oct. 1, 2023, coverage for the Humira biosimilars, Hadlima and Adalimumab-adaz (manufactured by Sandoz) was added to our Medicare, commercial and individual member formularies.

How will this impact you?

We’ll no longer authorize Humira for commercial group and individual members starting Dec. 31, 2023. To ease the transition, we have prior authorization approvals in place for Hadlima and Adalimumab-adaz which began on Oct. 1, 2023.

Members will need a new prescription to transition to Hadlima or Adalimumab-adaz.

Medicare members with existing prescriptions for Humira will continue through 2024.

How are we communicating this to members?

Impacted members will receive a letter advising them of their drug coverage changes and what steps they can take prior to Jan. 1, 2024.

To avoid interruptions in their Tumor Necrosis Factor (TNF) inhibitor therapy, members are encouraged to speak with their providers about whether transitioning to Hadlima or Adalimumab-adaz is right for them.

Thank you for partnering with us in our commitment to providing affordable and effective therapies to your patients, our members.