Does Medicare Part D cover Stelara?
Coverage, cost, and 2026 details for Stelara (ustekinumab) under Medicare Part D.
Quick answer: Yes, Stelara is generally covered by Medicare Part D plans, typically on Tier 5 (specialty). Coverage details, copays, and restrictions vary by plan, so compare plans available in your area to find the best coverage for your medications.
What is Stelara?
Stelara (ustekinumab) is an injectable biologic for moderate-to-severe psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. It's administered as an injection (usually every 8–12 weeks after initial doses). Stelara is one of the 10 Medicare-negotiated drugs starting in 2026.
Is Stelara covered by Medicare Part D?
Stelara is covered by most Medicare Part D plans on Tier 5 (specialty), and may be administered under Part B in clinical settings. The Medicare negotiated price reduces the list price by 66% starting January 2026. The $2,100 out-of-pocket cap limits maximum costs to enrollees.
Typical formulary tier
Stelara is most often listed on Tier 5 (specialty) of Part D formularies. The exact tier — and the copay — depends on the specific plan you're enrolled in.
How much does Stelara cost with Medicare Part D?
Without insurance, Stelara costs around $14,000 per dose before negotiation at retail pharmacies. With Medicare Part D coverage, you typically pay The $2,100 annual cap limits your maximum out-of-pocket cost. Most Stelara users hit the cap with their first dose..
Your actual cost depends on:
- Your plan's deductible — up to $615 in 2026
- The tier Stelara is on in your plan's formulary
- Whether you've reached the $2,100 annual out-of-pocket cap
- Whether you qualify for Extra Help (Low-Income Subsidy)
- Whether you've enrolled in the Medicare Prescription Payment Plan (M3P), which spreads costs across the year
2026 Medicare-negotiated price
Stelara is one of the 10 drugs whose prices were negotiated by Medicare under the Inflation Reduction Act. Starting January 1, 2026, the negotiated price reduces the Medicare list price by 66%.
This negotiated price is what Medicare pays to the manufacturer. Your specific copay depends on your plan's tier structure and where you are in the Part D coverage phases. The negotiation is expected to flow through to lower costs for many enrollees, especially as plans adjust their formularies and tiers for 2026.
See all 10 negotiated drugs and 2026 prices →
How to lower your Stelara costs
1. Compare Part D plans for your specific drugs
The same drug can cost dramatically different amounts on different plans. During the Annual Enrollment Period (October 15 – December 7), use the Medicare.gov Plan Finder to compare what Stelara would cost across every plan available in your ZIP code.
2. Check if you qualify for Extra Help
If your income is below approximately $23,475 (single) or $31,725 (married couple) in 2026, you likely qualify for Extra Help, which dramatically reduces what you pay for Stelara and all your medications. Learn about Extra Help →
3. Use the Medicare Prescription Payment Plan (M3P)
M3P doesn't lower your total cost, but it spreads your annual out-of-pocket costs into monthly installments — which can help if Stelara causes a big upfront pharmacy bill. Learn about M3P →
4. Look into Patient Assistance Programs
Janssen (Johnson & Johnson) may offer a Patient Assistance Program for people with limited income who don't qualify for Extra Help. These programs can provide free or deeply discounted medication directly from the manufacturer. Learn more about manufacturer programs →
5. Ask about alternatives
Talk to your doctor about whether a different medication — including a generic version or a similar drug in the same class — would work for you.
Alternatives to Stelara
Other medications used for psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis include:
- Skyrizi (risankizumab)
- Tremfya (guselkumab)
- Humira (adalimumab) and biosimilars
- Cosentyx (secukinumab)
- Taltz (ixekizumab)
Always discuss any medication change with your prescribing doctor.
Key facts about Stelara on Medicare
- 66% Medicare price reduction starting January 2026
- $2,100 annual out-of-pocket cap limits costs to enrollees
- First biosimilar candidates expected after 2025
Frequently asked questions about Stelara on Medicare
Does Medicare cover Stelara?
Yes, Stelara is generally covered by Medicare Part D plans, most often on Tier 5 (specialty). Coverage and costs vary between plans, so compare plans available in your area. Some plans require prior authorization.
How much does Stelara cost on Medicare Part D?
Costs typically range from The $2,100 annual cap limits your maximum out-of-pocket cost. Most Stelara users hit the cap with their first dose.. Your actual cost depends on your plan's deductible, the tier Stelara is on, and whether you've reached the $2,100 annual out-of-pocket cap.
Is there a generic version of Stelara?
No, there is no generic version of Stelara currently available. Patent expirations and FDA approvals will eventually allow generics, but the timing varies. Talk to your doctor about other medications in the same class that may have generic options.
What if my Part D plan doesn't cover this drug?
You have several options: (1) Switch to a different Part D plan during Annual Enrollment that covers Stelara, (2) Request a formulary exception from your current plan with your prescriber's support, (3) Ask your doctor about a covered alternative medication, or (4) Look into the manufacturer's Patient Assistance Program if you have limited income.
Did Medicare negotiate the price of Stelara?
Yes. Stelara is one of the 10 drugs whose prices were negotiated by Medicare under the Inflation Reduction Act. Starting January 1, 2026, the negotiated price reduces the Medicare list price by 66%.
Compare your Part D options
Coverage and costs for this drug vary significantly between plans. Compare your options:
You can also visit Medicare.gov or call 1-800-MEDICARE