Does UPMC for Life PPO Rx Enhanced (PPO) cover adalimumab?
UPMC for Life PPO Rx Enhanced (PPO)
H5533-005-0 · MA_LOCAL · Medicare Part D
adalimumab
Do you get help with your Medicare drug costs?None of these
Optional. Some plans charge less at a preferred pharmacy. Enter your ZIP to see which pharmacies near you take this plan — pick yours and the price above is re-worked for it. Until you do, we show what a standard pharmacy costs. Nothing here is saved.
adalimumabunder UPMC for Life PPO Rx Enhanced (PPO)
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
33%of the price your plan negotiates
Medicare hasn’t published this plan’s negotiated price for this drug yet — that file is updated every three months, and newly launched drugs appear in it late. Your pharmacy can quote the exact amount today. Part D caps what you pay out of pocket at $2,100 for 2026. From the first fill — no deductible on this drug.
This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.
Amount limit applies — how much depends on the strength you are prescribed — the cap for each one is listed below. You can still fill it; more than that needs your plan's approval, which your doctor's office requests.
- Tier
- Tier 5
- Approval first
- Required
- Try another first
- No
- Amount limit
- Varies by strength
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 16, 2026 · CMS Part D monthly PUF. Reference information, not medical advice and not a price.
Covered forms and strengths (19)
- 0.2 ML adalimumab-adbm 50 MG/ML Prefilled SyringeTier 5Approval first4 syringes per 28 days
- 0.2 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo]Tier 5Approval first4 syringes per 28 days
- 0.2 ML adalimumab-ryvk 100 MG/ML Prefilled Syringe [Simlandi]Tier 5Approval first4 syringes per 28 days
- 0.4 ML adalimumab-adbm 100 MG/ML Auto-InjectorTier 5Approval first4 pens per 28 days
- 0.4 ML adalimumab-adbm 100 MG/ML Auto-Injector [Cyltezo]Tier 5Approval first4 pens per 28 days
- 0.4 ML adalimumab-adbm 100 MG/ML Prefilled SyringeTier 5Approval first4 syringes per 28 days
- 0.4 ML adalimumab-adbm 100 MG/ML Prefilled Syringe [Cyltezo]Tier 5Approval first4 syringes per 28 days
- 0.4 ML adalimumab-adbm 50 MG/ML Prefilled SyringeTier 5Approval first4 syringes per 28 days
- 0.4 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo]Tier 5Approval first4 syringes per 28 days
- 0.4 ML adalimumab-ryvk 100 MG/ML Auto-InjectorTier 5Approval first6 pens per 28 days
- 0.4 ML adalimumab-ryvk 100 MG/ML Auto-Injector [Simlandi]Tier 5Approval first6 pens per 28 days
- 0.4 ML adalimumab-ryvk 100 MG/ML Prefilled SyringeTier 5Approval first6 syringes per 28 days
- 0.4 ML adalimumab-ryvk 100 MG/ML Prefilled Syringe [Simlandi]Tier 5Approval first6 syringes per 28 days
- 0.8 ML adalimumab-adbm 50 MG/ML Auto-InjectorTier 5Approval first4 pens per 28 days
- 0.8 ML adalimumab-adbm 50 MG/ML Auto-Injector [Cyltezo]Tier 5Approval first4 pens per 28 days
- 0.8 ML adalimumab-adbm 50 MG/ML Prefilled SyringeTier 5Approval first4 syringes per 28 days
- 0.8 ML adalimumab-adbm 50 MG/ML Prefilled Syringe [Cyltezo]Tier 5Approval first4 syringes per 28 days
- 0.8 ML adalimumab-ryvk 100 MG/ML Auto-InjectorTier 5Approval first4 pens per 28 days
- 0.8 ML adalimumab-ryvk 100 MG/ML Auto-Injector [Simlandi]Tier 5Approval first4 pens per 28 days