Specialty Drugs on 2027 SC Plans: Humira, Dupixent, Skyrizi, Stelara, Xolair
If you take one of these five drugs, two questions decide your 2027 costs: is the drug on the plan's covered drug list, and does the plan charge a flat copay or a percentage. Both answers vary by insurance company and by plan.
Published · Updated · 4 min read
In this guide
If you buy your own coverage in South Carolina and take Humira, Dupixent, Skyrizi, Stelara or Xolair, start with the covered drug list. For 2027, BlueCross BlueShield of SC, First Choice Next and Oscar list all five. Ambetter lists four and leaves off Xolair. InStil lists Humira, Stelara and Xolair and leaves off Dupixent and Skyrizi.
Every one of these listings requires prior authorization, so plan on an approval step with any company.
Then look at what the plan charges. Some 2027 plans charge a flat $250 copay for a specialty drug. Others charge 40% or 50% of the drug's price, often only after you meet the deductible.
Which insurance companies list Humira, Dupixent, Skyrizi, Stelara and Xolair for 2027?
Scroll sideways for more columns
| Drug | Ambetter | BlueCross BlueShield of SC | First Choice Next | InStil | Oscar |
|---|---|---|---|---|---|
| Humira (adalimumab) | Listed, specialty | Listed, preferred specialty | Listed, preferred specialty | Listed, preferred specialty | Listed, specialty |
| Dupixent (dupilumab) | Listed, specialty | Listed, preferred specialty | Listed, preferred specialty | Not on the list | Listed, specialty |
| Skyrizi (risankizumab) | Listed, specialty | Listed, preferred specialty | Listed, preferred specialty | Not on the list | Listed, specialty |
| Stelara (ustekinumab) | Listed, specialty | Listed, preferred specialty | Listed, preferred specialty | Listed, non-preferred specialty | Listed, specialty |
| Xolair (omalizumab) | Not on the list | Listed, preferred specialty | Listed, preferred specialty | Listed, preferred specialty | Listed, specialty |
From Murdock Insurance Group's review of each company's 2027 covered drug list. Every listing in this table requires prior authorization. Every listing from Ambetter, BlueCross BlueShield of SC, InStil and Oscar also has a quantity limit. First Choice Next's listings show prior authorization only.
Drug lists can change; we verify with the insurance company before you enroll. Last verified: November 2026.
What this means by company:
- BlueCross BlueShield of SC, First Choice Next and Oscar list all five drugs. BlueCross BlueShield of SC sells in all 46 counties. First Choice Next sells in 27. Oscar sells in Charleston, Colleton, Florence, Horry, Marion and York.
- Ambetter sells in all 46 counties and lists Humira, Dupixent, Skyrizi and Stelara. Xolair is not on its list.
- InStil sells in Chesterfield, Darlington, Florence and York. It lists Humira and Xolair as preferred specialty drugs and Stelara as non-preferred. Dupixent and Skyrizi are not on its list.
- UnitedHealthcare sells in nine counties for 2027, listed in our UnitedHealthcare article. Its drug list is not in our data, so check the plan's covered drug list or ask us to.
In the 11 counties where only Ambetter and BlueCross BlueShield of SC sell, a Xolair patient has one company whose list includes the drug.
What will I pay for a specialty drug on a 2027 plan?
The drug list tells you whether a drug is covered. The plan's benefits tell you the price. Two plans from the same insurance company can charge very different amounts for the same drug.
| What the plan charges for a specialty drug | 2027 plans |
|---|---|
| $250 copay | The standard gold design: Ambetter Signature Gold, BlueCross BlueShield of SC's Standard Gold plans and BlueConnect Gold 1, First Choice Next Gold Signature, InStil InHealth Basic Plus Standard, Oscar Gold Classic Standard |
| 25% of the drug's price | BlueCross BlueShield of SC BlueEssentials Gold 1 |
| $350 copay, after a $6,400 deductible | The standard silver design: Ambetter Signature Silver, BlueCross BlueShield of SC's Standard Silver plans and BlueConnect Silver 1, First Choice Next Silver Signature, InStil InHealth Basic Standard, Oscar Silver Classic Standard |
| $500 copay, after a $7,500 deductible | The standard expanded bronze design: Ambetter Signature Expanded Bronze, BlueCross BlueShield of SC's Standard Expanded Bronze plans and BlueConnect Bronze 1, First Choice Next Bronze Signature, Oscar Bronze Classic Standard |
| 40% of the drug's price | First Choice Next Gold Copay Focus (no deductible). After the deductible: First Choice Next Gold Enhanced, Silver Essential and Bronze Enhanced, and BlueCross BlueShield of SC BlueEssentials Silver 40 |
| 45% to 50% of the drug's price | Ambetter Elite Gold (50%, no deductible). After the deductible: Ambetter's Streamlined Silver (45%), Focused Silver, Everyday Gold and Everyday Bronze; most other BlueCross BlueShield of SC plans; InStil InHealth Basic 2; most other Oscar plans |
| Full price until you meet the deductible, then $0 | BlueCross BlueShield of SC's Bronze 2 plans ($10,600 deductible), First Choice Next Bronze Essential ($12,000 deductible) and InStil InHealth Basic 1 ($12,000 drug deductible) |
In-network amounts for individual coverage from 2027 plan data. Versions of these plans with adult dental and vision use the same drug cost-sharing. The table does not list every plan.
A few details to check before you pick:
- A flat copay is easier to budget. On the standard gold design you pay $250 per specialty fill, with a $2,500 medical deductible and an $8,600 yearly limit on what you pay.
- A percentage is tied to the drug's price. We do not have drug prices in our data, so ask the insurance company or pharmacy what 40% or 50% comes to for your drug.
- Some plans have a separate drug deductible. Ambetter Elite Bronze has a $0 medical deductible but a $4,500 drug deductible before its 50% specialty coinsurance applies. BlueCross BlueShield of SC BlueEssentials Gold 5 has a $1,000 drug deductible.
- InStil lists Stelara as non-preferred specialty. Our plan data shows one specialty drug cost per plan. Ask InStil which amount applies to a non-preferred specialty drug.
Whatever the plan charges, your spending on covered in-network care stops at the plan's yearly limit on what you pay. Our metal levels guide compares those limits, and our $0 deductible plans article covers the plans with separate drug deductibles.
Does a lower income change what I pay for specialty drugs?
It can. If your income is under 250% of the federal poverty level, silver plans come with cost-sharing reductions that lower the deductible and the yearly limit on what you pay. The amounts in the table above are for plans without those reductions. Our cost-sharing reductions guide explains who qualifies.
What should I confirm before I enroll?
- The drug is on the 2027 list. Look up the exact drug name on the insurance company's 2027 covered drug list. Our guide to checking your doctors and prescriptions shows where to find it.
- The approval steps. Every listing above requires prior authorization. HealthCare.gov defines that as the insurer's decision that a drug is medically necessary, and notes that it isn't a promise the plan will cover the cost. If you are changing insurance companies, ask your doctor's office about a new request early.
- The plan's specialty drug cost. Read the Summary of Benefits and Coverage for the exact plan, including any drug deductible.
- Your prescriber is in the network. Almost every 2027 plan in South Carolina is an HMO, and the rest are BlueCross BlueShield of SC's EPO plans. Neither type covers out-of-network care except emergencies.
If your drug is not on a plan's list, HealthCare.gov says you have the right to follow the insurance company's drug exceptions process. The details differ by plan, and an exception is a request, not a promise.
Common questions
All five in our data list Humira (adalimumab) for 2027: Ambetter, BlueCross BlueShield of SC, First Choice Next, InStil and Oscar. Each requires prior authorization.
Not in our 2027 data. Xolair is not on Ambetter's covered drug list. BlueCross BlueShield of SC, First Choice Next, InStil and Oscar list it.
No. Neither drug is on InStil's 2027 drug list in our data. InStil does list Humira, Stelara and Xolair.
The standard gold plans charge a $250 copay. The standard silver plans charge $350 and the standard expanded bronze plans charge $500, both after the deductible. Ambetter, BlueCross BlueShield of SC, First Choice Next and Oscar sell all three. InStil sells the gold and silver versions.
Not always. Gold plans usually cost more each month, and several gold plans charge 40% or 50% for specialty drugs. Compare the plan's specialty drug cost, deductible and yearly limit on what you pay against the premium.
Open enrollment runs November 1, 2026 to January 15, 2027. Enroll by December 15 for coverage that starts January 1. Our 2027 open enrollment guide has every date.
Match your drug to a plan before you enroll
Send us your drug name and dose, your prescriber, your ZIP code, and your household size and income. A licensed agent will check which 2027 plans in your county list the drug, what each charges, and the price after your tax credit.
Sources
- Getting prescription medications (HealthCare.gov)
- Preauthorization — glossary (HealthCare.gov)
- Murdock Insurance Group analysis of 2027 SC Marketplace rate filings / plan data (covered drug lists for marker drugs, plan benefits)
This article is general information about plan coverage, not medical advice. Talk to your doctor about your treatment. Cost-sharing figures are in-network amounts for individual coverage; check each plan's Summary of Benefits and Coverage for limits and exclusions. Your actual cost depends on your age, income, household size, tobacco use and the plan you choose. Drug lists can change; we verify with the insurance company before you enroll. Last verified: November 2026. Murdock Insurance Group is a licensed independent insurance agency. We are not affiliated with HealthCare.gov, any government agency or any drug manufacturer.
Still deciding? Talk it through with a licensed agent.
Tell us your county and your doctors, and we'll compare every plan for you. Enroll by December 15 and your coverage starts January 1. Our service is at no cost to you.