Stelara® Medicare Coverage

Stelara is a prescription medication that contains the active ingredient Ustekinumab.

Stelara is given either IV or subcutaneously into the fatty part of the skin. Stelara is given once every 4 to 12 weeks depending on the condition being treated.

Stelara binds to and reduces inflammatory substances in the body to improve Chron’s disease, plaque psoriasis and psoriatic arthritis.

The major side effects of Stelara include feeling tired or weak, headache, vomiting, nose and throat irritation, signs of a common cold and irritation where the shot is given.

How much does Stelara cost with Medicare?

Stelara coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Stelara?

According to GoodRx, 79% of Medicare Advantage plans and Medicare Part D plans covered Stelara in 2023.¹

• Medicare Advantage plans or Part D plans that cover Stelara include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Stelara. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Additional information

If you are using Stelara subcutaneously at home, the place on the body where you give the shot should be rotated each time you give it. If you have the solution for injection at home, store it in the refrigerator and make sure it does not freeze.

If the medication is given as an infusion, a healthcare provider will do it for you.

Stelara increases the risk of getting an infection. Stay away from people who are sick and be sure to wash your hands often. If you have any infection, are taking antibiotics now or in the recent past or have had many infections, talk with your doctor.

You should consult your doctor before getting any vaccines while taking Stelara. Vaccine use with this drug may either raise the chance of an infection or make the vaccine not work.

Stelara can increase the risk of certain cancers such as skin cancer. Have your skin checked often and tell your doctor if you notice any alarming changes.

Stelara has not shown increased risks in pregnant patients, but other agents are preferred in pregnant women for treatment of these conditions.

It is not known if Stelara is present in breastmilk, and patients should use caution while taking this medication and breastfeeding.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.