{"id":628201,"date":"2024-05-10T17:10:09","date_gmt":"2024-05-10T21:10:09","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=628201"},"modified":"2024-10-25T09:57:35","modified_gmt":"2024-10-25T13:57:35","slug":"stelara-savings","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/stelara-savings\/","title":{"rendered":"How to save on Stelara: Copay card, patient assistance & more"},"content":{"rendered":"

For people with chronic inflammatory illnesses like <\/span>psoriasis<\/span><\/a>, psoriatic arthritis, and <\/span>inflammatory bowel disease<\/span><\/a> (which includes Crohn’s disease and ulcerative colitis), using the injectable drug <\/span>Stelara<\/span><\/a> (ustekinumab) may reduce their symptoms and make it easier for them to manage their illnesses. Stelara is in a class of drugs called <\/span>biologics<\/span><\/a>, which uses living cells to block some of the proteins known to cause inflammation. <\/span><\/p>\n

RELATED: Stelara infusion: What to expect<\/a><\/strong><\/p>\n

Stelara is also a specialty drug, which means it’s usually only available from certain pharmacies and requires special handling, according to <\/span>Christie Kunde, Pharm.D.<\/span><\/a>, of Informed Rx. This can also make Stelara cost more or limit insurance coverage. 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.<\/span><\/p>\n

How much does Stelara cost?<\/span><\/h2>\n

According to Stelara’s manufacturer, <\/span>Janssen Biotech, Inc.<\/span><\/a>, the list price of Stelara is $25,497.12 for an eight-week supply. For many people, Stelara is only affordable with insurance coverage, savings cards, patient assistance programs, or government assistance.<\/span><\/p>\n

Insurance coverage can vary greatly, so it’s important to contact your health insurance company for details about whether it covers Stelara and, if so, what you can expect to pay for it. Many commercial and private insurance plans provide coverage for 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. <\/span><\/p>\n

Stelara cost with Medicaid and Medicare <\/span><\/h3>\n

In general, Medicaid and Medicare cover Stelara for the treatment of <\/span>autoimmune conditions<\/span><\/a>, but <\/span>prior authorization<\/span><\/a>—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,” says <\/span>Christina M. Madison, Pharm.D.<\/span><\/a>, founder and CEO of The Public Health Pharmacist.<\/span><\/p>\n

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.<\/span><\/p>\n

Although Stelara is sometimes given as an infusion by a healthcare provider instead of a self-administered injection, it is still usually covered under Medicare Part D, which helps patients pay for prescription medicines. 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) before you reach a cap on your spending that relieves you from any further expenses for the rest of the calendar year. Medicare offers an <\/span>online tool<\/span><\/a> you can use to compare plans that cover Stelara.<\/span><\/p>\n

As recently as 2022, the average out-of-pocket <\/span>cost of Stelara for a person enrolled in Medicare<\/span><\/a> was more than $2,000 per year. In 2023, Stelara was one of 10 drugs selected for the first cycle of Medicare drug price negotiations, which will hopefully lower the price of certain high-spending, brand-name, Medicare Part B and Part D drugs that lack competition. Negotiated prices under <\/span>the new law<\/span><\/a> will be effective in 2026. Manufacturers that don’t comply will have to pay a tax and penalties.<\/span><\/p>\n

How to save money on Stelara<\/span><\/h2>\n

​Are you wondering what your savings options are for your Stelara prescription? Here are the best ways to cut your costs.<\/span><\/p>\n

1. STELARA withMe Savings Program <\/span><\/h3>\n

Janssen Biotech, Inc. has a support program called <\/span>Janssen CarePath<\/span><\/a> to help eligible patients save money on Stelara. Through the website, you can access the <\/span>STELARA withMe Savings Program<\/span><\/a>, which is available to most commercially and privately insured patients who are prescribed Stelara. <\/span><\/p>\n

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, and there are no income requirements for eligibility. However, the amount you’ll pay with the program still depends on the benefits of your health insurance plan, including deductibles and other shared costs, so make sure you know your plan benefits or talk to a savings program representative if you have questions. You can reach a representative online or by calling 844-494-8463. <\/span><\/p>\n

There are three ways to enroll in the Stelara withMe savings program and receive your Stelara savings card:<\/span><\/p>\n

    \n
  1. Creating an account and enrolling <\/span>online<\/span><\/a><\/li>\n
  2. Calling 844-494-8463<\/span><\/li>\n
  3. Faxing or mailing an <\/span>enrollment form<\/span><\/a> to the fax number or address listed on the form<\/span><\/li>\n<\/ol>\n

    2. Janssen Patient Assistance Program<\/span><\/h3>\n

    The manufacturer of Stelara offers the <\/span>Janssen Patient Assistance Program<\/span><\/a> for insured patients who are facing access and affordability challenges. You may be eligible for the program if you:<\/span><\/p>\n