Drug Information
Drug	Humira 20mg Inj. - Crohns
Generic Equivalent	adalimumab
Class	Crohns
Topic	Tumor Necrosis Factor blocker
Program Contact Info / Application Submission
Program	Humira PAP - Crohns
Company	AbbottHum
Form	Download PDF
Address	PO Box 789, San Bruno, CA 94066
Phone	800-222-6885 opt 4 opt 1
Fax	866-323-0661
Website	http://www.humira.com
Program Requirements
Details	Insurance card NOT required Drivers license required Proof of Income required Copy of most recent tax return such as 1040, 1099 required as proof of income Form 4506T (If taxes were not filed) NOT required as proof of income Most recent bank statements NOT required as proof of income Most recent check/check stub copy required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement required as proof of income Award Letter for Alimony/Child Support, Unemployment required as proof of income
Delivery of Medication
Ship Time	10 - 14 business days
Delivery Options	Can be delivered directly to the patient Can be delivered directly to the doctor
Application Process
New Applications	Patients can apply directly to the program Doctors can apply directly to the program Advocates can apply directly to the program Can apply for a new application via fax Can apply for a new application via mail
Refills	Refills accepted Patients can apply for refills Doctors can apply for refills Advocates can NOT apply for refills Can apply for refills via phone Can NOT apply for refills via fax Can NOT apply for refills via mail
Re-Applications	Re-Applications accepted Patients can apply for Re-Applications Doctors can apply for Re-Applications Can Re-Apply via phone Can NOT Re-Apply via fax Can NOT Re-Apply via mail
Appeals	Income Appeals accepted Patients can apply for Income Appeals Hardship Appeals accepted Patients can apply for Hardship Appeals Can apply for an appeal via phone Can apply via fax Can apply for an appeal via mail
Eligibility
Limitations	Patients are eligible if LIS is denied Patients are eligible with existing prescription coverage Patients are eligible if prescription is not covered Patients are NOT eligible if prescription coverage has been exhausted Patients are NOT eligible if they are accepting Medicare Patients are eligible if they are accepting Medicare part D Patients are NOT eligible if the medication is not covered under Medicare
Appeals
Conditions	Appeals will consider out-of-pocket expenses Appeals will consider total medical expenses
Other Medications
Other  Medications  available in  this program	Humira 20mg Inj. - Crohns - Crohns Tumor Necrosis Factor blocker (Generic: adalimumab) Humira 40mg Inj. - Crohns - (Generic: adalimumab)