ArcaMax

Hello, Toni:

You helped me sign up for a Medicare Supplement Plan G and a Medicare Part D prescription drug plan; both plans started January 2021. These two plans have served me well so far.

I just received information that my current Part D plan will no longer cover the Humira that I take twice a month as an injection for Crohn’s disease. I have looked at other 2026 Medicare Part D plans on the Medicare.gov site and discovered that there is not one that is covering Humira.

Toni, do you know of another Part D provider you can sign me up for that will cover some or all of the costs for Humira? Any recommendations you can make will be highly appreciated. Thanks, Toni.

—Gene from Sugar Land, Texas

Gene:

I do not have good news about Humira, this important prescription for your Crohn’s. You’re right, Gene: I also searched the Medicare.gov site for Humira without finding a stand-alone Medicare Part D plan that covered it. The website showed that the total cost beginning January 1, 2026, for all 12 months of Humira will be $99,691.68, or $8,307.64 per month.

I did research on Google, asking “Why is Medicare not covering Humira for 2026?,” with AI giving this answer: “Medicare Part D plans are not covering Humira in their 2026 formularies because they are increasingly switching to cheaper Humira biosimilars.” AI also said, “While some plans are removing the brand-name drug, they are still providing coverage for the drug class through its biosimilars to help reduce drug spending.”

I have never seen the word “biosimilar” associated with Medicare Part D prescriptions since Medicare Part D began on January 1, 2006, so I also googled “biosimilar prescriptions.” These are explained as “lower-cost versions of expensive biologic drugs, under Medicare Part B and Part D.” Gene, other prescriptions that are similar to Humira and are less expensive may be covered and are what you might want to change to.

What I would suggest that you do, Gene, is call the physician that has prescribed you Humira and ask what alternative prescriptions you can be changed to. Also, contact AbbVie, the manufacturer of Humira, at 1-800-222-6885 and ask if you qualify to receive any type of prescription drug assistance, or visit the www.AbbVie.com website for more information.

This Medicare Open Enrollment has been the most stressful fall Medicare OEP that I have ever experienced since Open Enrollment began. It is extremely important that the 69 million Americans who are on Medicare visit www.medicare.gov to verify that ALL of their prescriptions are covered, whether they have a stand-alone Medicare Part D plan or a Medicare Advantage HMO/PPO plan with a Prescription Drug plan included. (On Thursday, Nov. 20, at 4 p.m. CST, Toni will host the online workshop “Confused about Medicare” on Zoom to explain Medicare Part D. Visit www.tonisays.com to register.)

Below are the 2026 Medicare Prescription Drug Costs and maximum out of pocket:

—Initial deductible is $615.

—Initial coverage stage: During the initial coverage period with the six drug tiers, the Part D plan pays its share of the cost of your drugs, and you pay your share of the cost until the maximum amount of $2,100 out of pocket is met. Then you move to the catastrophic coverage stage.

—Catastrophic coverage: There is a $0 out of pocket once a Medicare beneficiary enters the catastrophic coverage stage. Medicare will pick up all costs of covered prescriptions whether brand-name or generic with a stand-alone Medicare Part D plan or a Medicare Advantage with a Part D plan included, and you will pay $0.

Readers, your prescription drug needs can change every Medicare OEP. Review your options carefully, because with Medicare, what you don’t know WILL hurt you! Email info@tonisays.com with your Medicare questions.

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Toni King is an author and columnist on Medicare, Social Security and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.

©2025 Toni King. Distributed by Tribune Content Agency, LLC.

Copyright 2025 Toni King, Distributed by Counterpoint Media