Stelara Cost in 2025: Medicare Part B Coverage Explained
Discover whether Medicare Part B covers Stelara in 2025 and learn how Medicare Part D can help manage the high cost of this autoimmune treatment.
Stelara (ustekinumab) is a powerful prescription medication used to treat autoimmune diseases like plaque psoriasis. It is administered either through subcutaneous injections or intravenous infusions under medical supervision.
In 2024, Medicare Part B does not cover Stelara since it is a medication patients can self-inject. However, Medicare Part D plans, which cover self-administered prescription drugs, often include Stelara in their formularies.
Why is Stelara Not Covered by Medicare Part B in 2024?
Prior to 2023, Medicare Part B covered subcutaneous Stelara injections if administered by a healthcare provider. Due to updated policies, Part B now only covers drugs that must be administered by medical professionals in clinical settings. Since Stelara can be self-injected, it falls outside Part B coverage.
Instead, Medicare Part D plans—offered by private insurers—typically cover Stelara, but coverage details vary by plan.
Stelara Pricing Under Medicare Part D in 2024
The list price for Stelara's 90 mg dose is approximately $25,497 every eight weeks as of early 2024. Medicare Part D beneficiaries won’t pay this full amount directly.
After meeting your deductible, you will pay coinsurance based on the drug’s formulary tier within your plan. Lower tiers mean lower copayments. Additionally, your exact out-of-pocket costs depend on prescribed dosage and availability of biosimilar alternatives.
Importantly, Medicare Part D caps annual out-of-pocket spending at $2,000 in 2024. After reaching this limit, Part D covers 100% of your prescription costs.
Note that you must also pay a monthly premium for Part D coverage, which varies by plan. The estimated national base premium for 2025 is $36.78.
Medicare Advantage plans with drug coverage may also cover Stelara, with costs varying similarly based on plan specifics.
Tips to Reduce Stelara Costs
To minimize expenses, check if your Medicare Part D or Advantage plan covers biosimilar versions of Stelara, which tend to be more affordable.
You may also qualify for Extra Help benefits based on income, which can significantly reduce out-of-pocket costs. Additionally, explore pharmaceutical assistance programs available in your state.
For more information, visit resources on Stelara and cost-saving options.
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