Patient Assistance options
You may be eligible to receive free HUMIRA if you:
- Have been prescribed HUMIRA
- Have limited or no health insurance coverage
- Live in the United States
- Are being treated by a licensed U.S. health care provider on an outpatient basis
If you have insurance, we will review your qualifying financial need based on a combination of your insurance coverage, household income, and out-of-pocket medical expenses during the application process. To help you understand the income guidelines that we use to evaluate qualifying financial need, we’ve provided the table below:
| Household size | Annual income |
| 1 | $81,540 or less |
| 2 | $109,860 or less |
| 3 | $138,180 or less |
| 4 | $166,500 or less |
| After 4, add $28,320 for each additional dependent family member |
If you would like to submit your application electronically, click below to apply online. We recommend the online application if you are at least 18 years old and have electronic copies of documents like tax returns or insurance cards.
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If the online application is not right for you and you would prefer to apply by fax or mail, please download the application below.
HUMIRA application (English)
HUMIRA application (English - Large Font)
HUMIRA application (Spanish)
Medicare patients may qualify for Extra Help from Medicare.
Savings card
Program eligibility details
If you have employer-provided insurance coverage or have purchased private insurance on your own, you may qualify for assistance with your out-of-pocket expenses. Visit HUMIRA.com.
Available to patients with commercial prescription insurance coverage who meet eligibility criteria. Copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This is not health insurance.