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Adults: (18 and older)
-or-
Pediatrics: (12 years and older and by weight)
≥60kg or 132 lbs
<60 kg or 132 lbs
**See the drug manufacturers website for more information**
This form is to be used for the starting and renewing of Humira Complete Support program.
This form is to be used for the starting and renewing of the Humira My AbbVie Assist PAF
The foundation form is used in applications in which the patients Humira PA is denied, the patient is uninsured, on Medicaid/Medicare, or they aren't eligible for copay assistance.
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