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Program Details

AbbVie
myAbbVie Assist for Humira

HUMIRA (adalimumab)
 
CONTACT INFO
Address: D-617927, AP5 NE
1 N. Waukegan Rd.
North Chicago, IL 60064
Phone: 1-800-222-6885 Provider Phone:
Fax: 1-866-250-2803 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Patient must not have health insurance OR limited insurance coverage (including Medicare) for an AbbVie medicine and meet financial criteria based on household income and out-of-pocket medical expenses.
  • Income at or below: Single 600 % FPL
      Couple 600 % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Copy of insurance cards, if applicable
    Physician License #
    Required:
    NPI
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    Shipped To: Patient
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: Not Published
    Refill Policy: Program will contact patient or provider to schedule next delivery.
    Other Information:

    Last Updated: 03/19/2024

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)


    Document Form (Spanish)



     

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