Stelara copay card and savings guide

In this article:

• How much does Stelara cost?
• Stelara cost with Medicaid and Medicare 
• How to save money on Stelara
• Is there a cheaper alternative to Stelara?

In this article

• How much does Stelara cost?
• Stelara cost with Medicaid and Medicare 
• How to save money on Stelara
• Is there a cheaper alternative to Stelara?

For people with chronic inflammatory illnesses like psoriasis, psoriatic arthritis, and inflammatory bowel diseases (Crohn’s disease or ulcerative colitis), using the injectable drug Stelara (ustekinumab) may reduce their symptoms and make it easier for them to manage their illness. It’s also a premium-priced specialty drug sold only through specialty pharmacies. Even with insurance, the out-of-pocket cost may be challenging. If you’ve been prescribed Stelara and are looking for ways to lower the price of your prescription, we have information that can help. Here are our top tips for saving money on Stelara.

RELATED: Stelara infusion: What to expect

How much does Stelara cost?

The average retail price of Stelara is $17,369 for a single injection. That’s enough medicine to last for eight weeks, though some people may take doses every 12 weeks. For many people, Stelara is only affordable with insurance coverage, savings cards, or government assistance.

Insurance coverage can vary greatly, so it’s important to contact your health insurance company for details about whether it covers Stelara. Many commercial and private insurance plans cover Stelara, but some only cover it for certain uses. For example, they might cover it for inflammatory bowel disease but not for psoriasis or psoriatic arthritis. They may also impose restrictions on coverage, like prior authorization or step therapy. The out-of-pocket cost may be high, since many insurance plans put the drug in their highest copay tiers.

How to save money on Stelara

​If you’re wondering what your savings options are for your Stelara prescription, there are ways to cut your costs.

1. SingleCare coupons

A SingleCare coupon for Stelara can reduce the cost from $17,369 to $3,566 for 1, 0.5 mL of 45 mg/0.5 mL syringe of a Stelara biosimilar. Members can save even more, and it’s free to sign up.

2. STELARA withMe savings program 

The Stelara withMe savings program (which, in reality, is just one part of the JJ&Me Savings Program) is available to most commercially and privately insured patients who are prescribed Stelara. The program can help adults and children ages 6 and older access a year’s supply of Stelara for as little as $5 per dose. 

The actual amount you’ll pay with the program depends on your health insurance benefits, including deductibles and other shared costs. Additionally, not all health insurance plans will qualify. Some insurance plans either don’t count copay assistance toward the patient’s annual deductible or increase the out-of-pocket cost to match the copay program’s maximum limit. You can enroll in the JJ&Me savings program online, by phone, by fax, or by mail. Once enrolled, you’ll receive a Stelara copay card that you can present to pharmacy staff when paying for your prescription.

The manufacturer, Johnson & Johnson, no longer offers a Stelara patient assistance program for uninsured or underinsured patients. 

3. Government-funded assistance 

All states except Alaska, Hawaii, Nebraska, Oklahoma, and West Virginia offer pharmaceutical assistance programs to help residents pay for their prescriptions. The Medicare website has a tool you can use to look up programs available in your state. 

If you’re a Medicare beneficiary with limited income, you may want to consider Medicare Extra Help to help pay for Stelara. In order to qualify for Extra Help in 2024, beneficiaries must meet annual income and resource limits. Consult the website for details.

Is there a cheaper alternative to Stelara?

There are cheaper alternatives to Stelara, starting with Stelara biosimilars. 

Because Stelara is a biologic drug, it does not have a generic version. Instead, it has a biosimilar version. The biosimilar versions are very similar to Stelara, but they cost considerably less. A single dose (one syringe with 0.5 mL of 45 mg/0.5 mL) costs $5,191 on average. A SingleCare ustekinumab coupon can lower the price to $3,566.

Yesintek is another biosimilar version of ustekinumab. Its average retail price is $4,259 or one syringe containing 1 mL of 90mg/mL ustekinumab (one dose). The lowest SingleCare price is $2,468 at Kroger.

As mentioned above, biologic drugs have “biosimilars” rather than generic versions. Biosimilars are very similar to the brand-name biologic, with tiny structural differences. Despite these differences, they have the same safety and effectiveness as their brand-name counterpart. You can tell a drug is a biosimilar because the drug makers add a unique suffix to the name, like “ustekinumab-aekn,” to distinguish it from other similar drugs. 

There are currently several FDA-approved ustekinumab biosimilars, and more are coming. Examples include Wezlana (ustekinumab-auub) or Selarsdi (ustekinumab-aekn). These typically sell for about $7,000 to $10,000 per dose. A SingleCare discount card can reduce the price of some of these biosimilars to $4,000 to $5,000. 

Patients can always turn to biosimilars of other biologic drugs. “Humira and Remicade treat conditions like [the ones treated by] Stelara and have cheaper biosimilars available,” according to Christie Kunde, Pharm.D., of Informed Rx. For example, if you used SingleCare’s prescription discount card when paying for a prescription for Hulio, one of Humira’s biosimilars, your cost could be $975 for two kits of 40 mg/0.8 mL pens at Kroger.

“The cheapest alternatives to Stelara often have more serious side effects and may not be appropriate for all ages or for treating the specific conditions,” says Christina M. Madison, Pharm.D., founder and CEO of The Public Health Pharmacist. However, she says you can ask your healthcare provider about these cost-saving options:

• Mesalamine: $71 for 120, 1.2 g delayed-release tablets at CVS Pharmacy with a SingleCare coupon
• Sulfasalazine: $20 for 120, 500 mg tablets with a SingleCare coupon at Publix
• Oral glucocorticoids like prednisone or prednisolone: $3 for 10, 20 mg prednisone tablets at Walmart, and $24 for 240 mL of 15 mg/5 mL prednisolone solution at Walgreens with SingleCare coupons 
• Methotrexate: $12 for 24, 2.5 mg tablets at Walmart with a SingleCare coupon

Does Medicare cover Stelara?

In general, Medicare covers Stelara for the treatment of autoimmune conditions, but prior authorization, approval from your health insurance plan to receive a drug or service not normally covered, is usually required. “That’s because of the high cost of the drug, the type of medication it is (a monoclonal antibody treatment), and the indications for use,” Dr. Madison says.

Although Stelara is sometimes given as an infusion by a healthcare provider instead of a self-administered injection, it is only covered under Medicare Part D benefits. Under Part D, you may be responsible for paying a deductible and one or more copays or out-of-pocket medication costs (in addition to your monthly premium). Medicare offers an online tool you can use to compare plans that cover Stelara.

Does Medicaid cover Stelara? 

Medicaid coverage varies by state, though, and Medicare Part D plans vary as well, so talk to your healthcare provider or insurance provider about any additional steps needed to receive coverage for Stelara. If prior authorization is needed, you may have to show your insurance company proof that Stelara is a medically necessary drug for your treatment plan, such as a history of trying at least one lower-tier drug to treat your condition.

Bottom line

If you’re having trouble affording Stelara without insurance, you have options. SingleCare coupons and the JJ&Me Savings Program can make it more affordable, but switching to a biosimilar may be the most viable cost-saving option for many people.