FillMapModa Select Texas Standard Bronze

Does Moda Select Texas Standard Bronze cover adalimumab?

Moda Select Texas Standard Bronze
17933-17933TX0010010-0 · ACA · ACA Marketplace
adalimumab
adalimumabunder Moda Select Texas Standard Bronze
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$500per 30-day fill

Your plan’s deductible comes first — you pay the full price until it is met.

This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.

Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.
Tier
Specialty drugs
Approval first
Required
Try another first
No
Amount limit
Yes
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Covered forms and strengths (98)

  • {1 (0.4 ML adalimumab 100 MG/ML Prefilled Syringe [Humira]) / 1 (0.8 ML adalimumab 100 MG/ML Prefilled Syringe [Humira]) } Pack [Humira Pediatric Crohn's Disease Starter Package (2 count)]Approval firstAmount limit
  • {1 (0.4 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) / 1 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight < 40 KG]Approval firstAmount limit
  • {2 (0.4 ML adalimumab 100 MG/ML Auto-Injector [Humira]) / 1 (0.8 ML adalimumab 100 MG/ML Auto-Injector [Humira]) } Pack [Humira Pen 80 MG/0.8 ML and 40 MG/0.4 ML - Psoriasis/Uveitis Starter Package]Approval firstAmount limit
  • {2 (0.4 ML adalimumab-adaz 100 MG/ML Auto-Injector [Hyrimoz]) / 1 (0.8 ML adalimumab-adaz 100 MG/ML Auto-Injector [Hyrimoz]) } Pack [Hyrimoz Plaque Psoriasis Starter Kit]Approval firstAmount limit
  • {3 (0.8 ML adalimumab 100 MG/ML Auto-Injector [Humira]) } Pack [Humira Pen 80 MG/0.8 ML - Starter Package for Crohn's Disease, Ulcerative Colitis or Hidradenitis Suppurativa]Approval firstAmount limit
  • {3 (0.8 ML adalimumab 100 MG/ML Prefilled Syringe [Humira]) } Pack [Humira Prefilled Syringe 80 MG/0.8 ML Starter Pack - Pediatric Crohn's Disease]Approval firstAmount limit
  • {3 (0.8 ML adalimumab-aaty 100 MG/ML Auto-Injector [Yuflyma]) } Pack [Yuflyma Auto-Injector 80 MG/0.8 ML Starter Package for Crohn's Disease, Ulcerative Colitis or Hidradenitis Suppurativa]Approval firstAmount limit
  • {3 (0.8 ML adalimumab-aaty 100 MG/ML Auto-Injector) } PackApproval firstAmount limit
  • {3 (0.8 ML adalimumab-adaz 100 MG/ML Auto-Injector [Hyrimoz]) } Pack [Hyrimoz Crohn's and UC Starter Kit]Approval firstAmount limit
  • {3 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight > 40 KG]Approval firstAmount limit
  • {4 (0.4 ML adalimumab-adbm 100 MG/ML Auto-Injector [Cyltezo]) } Pack [Cyltezo Pen 40 MG/0.4 ML Starter Pack - Psoriasis]Approval firstAmount limit
  • {4 (0.4 ML adalimumab-adbm 100 MG/ML Auto-Injector) } PackApproval firstAmount limit
  • {4 (0.8 ML adalimumab 100 MG/ML Auto-Injector [Humira]) } Pack [Humira Pen 80 MG/0.8 ML - Starter Package for Pediatric Ulcerative Colitis]Approval firstAmount limit
  • {4 (0.8 ML adalimumab 50 MG/ML Auto-Injector [Humira]) } Pack [Humira Pen - Psoriasis Starter Pack]Approval firstAmount limit
  • {4 (0.8 ML adalimumab-aacf 50 MG/ML Auto-Injector [Idacio]) } Pack [Idacio Pen 40 MG/0.8 ML Starter Pack - Plaque Psoriasis]Approval firstAmount limit
  • {4 (0.8 ML adalimumab-aacf 50 MG/ML Auto-Injector) } PackApproval firstAmount limit
  • {4 (0.8 ML adalimumab-adbm 50 MG/ML Auto-Injector [Cyltezo]) } Pack [Cyltezo Pen 40 MG/0.8 ML Starter Pack - Psoriasis]Approval firstAmount limit
  • {6 (0.4 ML adalimumab-adbm 100 MG/ML Auto-Injector [Cyltezo]) } Pack [Cyltezo Pen 40 MG/0.4 ML Starter Pack - Crohn's Disease or Ulcerative Colitis]Approval firstAmount limit
  • {6 (0.4 ML adalimumab-adbm 100 MG/ML Auto-Injector) } PackApproval firstAmount limit
  • {6 (0.8 ML adalimumab 50 MG/ML Auto-Injector [Humira]) } Pack [Humira Pen - Crohn's Disease Starter Pack]Approval firstAmount limit
  • {6 (0.8 ML adalimumab-aacf 50 MG/ML Auto-Injector [Idacio]) } Pack [Idacio Pen 40 MG/0.8 ML Starter Package for Crohn's Disease or Ulcerative Colitis]Approval firstAmount limit
  • {6 (0.8 ML adalimumab-aacf 50 MG/ML Auto-Injector) } PackApproval firstAmount limit
  • {6 (0.8 ML adalimumab-adbm 50 MG/ML Auto-Injector [Cyltezo]) } Pack [Cyltezo Pen 40 MG/0.8 ML Starter Package for Crohn's Disease or Ulcerative Colitis]Approval firstAmount limit
  • 0.1 ML adalimumab 100 MG/ML Prefilled Syringe [Humira]Approval firstAmount limit
  • 0.1 ML adalimumab-adaz 100 MG/ML Prefilled SyringeApproval firstAmount limit
  • 0.1 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]Approval firstAmount limit
  • 0.2 ML adalimumab 100 MG/ML Prefilled Syringe [Humira]Approval firstAmount limit
  • 0.2 ML adalimumab-aaty 100 MG/ML Prefilled SyringeApproval firstAmount limit
  • 0.2 ML adalimumab-aaty 100 MG/ML Prefilled Syringe [Yuflyma]Approval firstAmount limit
  • 0.2 ML adalimumab-adaz 100 MG/ML Prefilled SyringeApproval firstAmount limit
  • 0.2 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]Approval firstAmount limit
  • 0.2 ML adalimumab-adbm 50 MG/ML Prefilled SyringeApproval firstAmount limit
  • 0.2 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo]Approval firstAmount limit
  • 0.2 ML adalimumab-atto 100 MG/ML Prefilled Syringe [Amjevita]Approval firstAmount limit
  • 0.2 ML adalimumab-atto 50 MG/ML Prefilled Syringe [Amjevita]Approval firstAmount limit
  • 0.2 ML adalimumab-ryvk 100 MG/ML Prefilled Syringe [Simlandi]Approval firstAmount limit
  • 0.4 ML adalimumab 100 MG/ML Auto-Injector [Humira]Approval firstAmount limit
  • 0.4 ML adalimumab 100 MG/ML Prefilled Syringe [Humira]Approval firstAmount limit
  • 0.4 ML adalimumab-aaty 100 MG/ML Auto-InjectorApproval firstAmount limit
  • 0.4 ML adalimumab-aaty 100 MG/ML Auto-Injector [Yuflyma]Approval firstAmount limit

← All coverage for adalimumab