![]() If your health plan removes HUMIRA from a co-pay maximizer program, you will return to eligibility for co-pay assistance up to the maximum annual benefit listed below. This amount is subject to change without notice. For such patients, except where prohibited by applicable state law, AbbVie may discontinue the availability of co-pay support at an amount not to exceed $4,000.00. Since you may be unaware whether you are subject to a co-pay maximizer program when you enroll in the co-pay assistance program, AbbVie will monitor program utilization data and reserves the right to discontinue co-pay assistance at any time if AbbVie determines that you are subject to a co-pay maximizer program. If you learn your insurance company or health plan has implemented either an accumulator adjustment program or a co-pay maximizer program, you agree to inform AbbVie of this fact by calling 1-800-4HUMIRA to discuss alternative options that may be available to support you. Any out-of-pocket costs remaining after the application of the savings card may not be paid by your health plan, pharmacy benefit programs, or any other program. You also agree that you are personally responsible for paying any amount of co-pay required after the savings card is applied. Except where prohibited by applicable state law, if your insurance company or health plan implements either an accumulator adjustment or co-pay maximizer program, you will not be eligible for, and agree not to use, co-pay assistance because these programs are inconsistent with our agreed intent that this program is solely for your benefit. Co-pay maximizers are programs in which the amount of your out-of-pocket costs is increased to reflect the availability of support offered by a manufacturer assistance program. An accumulator adjustment program is one in which payments made by you that are subsidized by manufacturer assistance do not count toward your deductibles and other out-of-pocket cost sharing limitations. Some health plans have established programs referred to as “accumulator adjustment” or “co-pay maximizer” programs. By enrolling in the co-pay assistance program, you agree that this program is intended solely for the benefit of you, the patient. ![]() If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the HUMIRA Complete Savings Card and patient must call HUMIRA Complete at 1-800-4HUMIRA to stop participation. Co-pay assistance program is not available to patients receiving reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. Eligibility: Available to patients with commercial insurance coverage for HUMIRA who meet eligibility criteria. This benefit covers HUMIRA ® (adalimumab) alone or, for rheumatology patients, HUMIRA plus one of the following medications: methotrexate, leflunomide, or hydroxychloroquine. If your plan automatically reimburses you, you do need to let them know that you have co-pay assistance.Terms and Conditions apply. If you have to file for reimbursement through your plan, simply do not file. This is actually due to IRS regulations that prohibit you from using pre-tax dollars for something that another entity is paying. The rules with co-pay assistance prohibit you from being reimbursed through an HSA or flexible spending account for amounts that they are actually paying. The only thing you need to be careful of is the health spending account. Even though the drug company paid the majority of our responsibility amount, the remainder of our medical expenses are covered by insurance at 100% for the rest of the year. In 2012, we met our out of pocket max (thanks to Remi-start) in the first week of February. Now that my boys are on Remicade, along with my daughter and myself, my family not only meets our deductible through drug company assistance, we meet our out of pocket maximum as well. So not only did they not care who paid it, they put things in motion so that the drug company would pay. When my boys were on Humira, the specialty pharmacy through our insurance company handled all of the paperwork and set them up for Humira co-pay assistance. The insurance company is not concerned by who pays the deductible, Their concern is the amount that they contractually must pay. Your deductible amount is determined by your insurance contract.
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