Apply for Assistance and Create an Account

If you’re struggling to pay for your HUMIRA, we encourage you to apply for help. All you have to do is fill out an application, and we’ll review your eligibility for our program. You will also be prompted to register on our website if you don't already have an account.

Online Application Not right For You?

If you are not the patient or do not have your required documents readily available to upload or do not want to submit form electronically, please download PDF version of the Form.

Already have an Account?

If you have already registered an account, please click on "Log in Here" to view past submitted applications.

Help 1-800-222-6885

DO YOU HAVE ANY QUESTIONS?

Call us at 1-800-222-6885 Option #4 Monday through Friday from 7:00 am to 7:00 pm Central Time.