Drug CostSeptember 20, 2026·10 min read·By Jacob Posner, Founder & Editor
Humira vs Enbrel vs Stelara vs Cosentyx vs Skyrizi: Biologics for Autoimmune Disease Cost Comparison in 2026
Humira, Enbrel, Stelara, Cosentyx, and Skyrizi are the five most-prescribed biologic drugs for rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, and ulcerative colitis, and their 2026 costs diverge dramatically depending on Medicare negotiation status and biosimilar competition. Enbrel and Stelara both carry Medicare-negotiated Maximum Fair Prices under the Inflation Reduction Act, $2,355 and $4,695 per month respectively, effective January 1, 2026, while Humira already has more than 10 FDA-approved biosimilars pushing cash prices as low as $550 per month. Cosentyx and Skyrizi remain full-price, patent-protected brands with no Medicare negotiation and no biosimilar competition in 2026. This comparison breaks down retail cash prices, GoodRx and specialty-pharmacy pricing, Medicare Part D and Medicaid rules, and each manufacturer's patient assistance program side by side.
Quick Answer: In 2026, brand-name biologic list prices for autoimmune disease range from about $6,922 per month for Humira to roughly $24,000 per single dose for Skyrizi (dosed every 12 weeks). Medicare Part D enrollees pay the IRA-negotiated Maximum Fair Price of $2,355 per month for Enbrel and $4,695 per 30-day supply for Stelara, both effective January 1, 2026; Humira was not selected for negotiation because generic biosimilar competition already existed, and Cosentyx and Skyrizi were not selected in either Round 1 (2026) or Round 2 (2027). More than 10 adalimumab biosimilars for Humira sell for $550 to $1,315 per month, and five ustekinumab biosimilars for Stelara launched in 2025. No biosimilar exists yet for Enbrel (blocked by patents until approximately 2029), Cosentyx (patent through January 2029), or Skyrizi (patent through approximately 2028). Each manufacturer runs a separate patient assistance program: AbbVie's myAbbVie Assist (Humira and Skyrizi, roughly 600% of the Federal Poverty Level), Amgen Safety Net Foundation (Enbrel), Janssen CarePath (Stelara, roughly 400% FPL), and the Novartis Patient Assistance Foundation (Cosentyx, roughly 500% FPL). All Part D out-of-pocket spending across any of these drugs counts toward the same 2026 annual $2,100 cap.
Humira (adalimumab), Enbrel (etanercept), Stelara (ustekinumab), Cosentyx (secukinumab), and Skyrizi (risankizumab) are the five biologic drugs most commonly prescribed for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis in the United States, with Stelara and Skyrizi also approved for Crohn's disease and ulcerative colitis. Humira and Enbrel block tumor necrosis factor-alpha (TNF-alpha), an inflammation-driving protein. Stelara blocks interleukin-12 and interleukin-23 (IL-12/23). Cosentyx blocks interleukin-17A (IL-17A). Skyrizi blocks interleukin-23 (IL-23) specifically at the p19 subunit. That mechanism difference does not change how each drug is billed, but the five drugs have sharply different Medicare negotiation status, biosimilar availability, and manufacturer assistance programs in 2026, which is why comparing them side by side matters more for your wallet than the immunology does. For single-drug detail, see the dedicated pages for Humira cost and Enbrel cost.
The Inflation Reduction Act of 2022, signed August 16, 2022, authorized CMS to negotiate Medicare drug prices directly with manufacturers for the first time. Enbrel and Stelara were both among the first 10 drugs selected for Round 1 negotiation, and their Maximum Fair Prices of $2,355 and $4,695 took effect January 1, 2026. Humira was excluded from that selection entirely because more than 10 adalimumab biosimilars had already launched by 2023, and the statute bars CMS from selecting drugs that already face generic or biosimilar competition. Cosentyx and Skyrizi were not chosen for Round 1, and neither appeared on the 15-drug Round 2 list CMS announced in January 2025 for prices effective in 2027 (a list dominated by semaglutide products, oncology drugs, and COPD inhalers). That means Cosentyx and Skyrizi patients on Medicare Part D pay standard formulary cost-sharing on the full list price in 2026, with no Maximum Fair Price ceiling and no negotiated relief on the horizon.
Patients switching between these five biologics for cost reasons should talk to their prescriber first, since none are clinically interchangeable and switching mechanisms of action can trigger a loss of disease control. Adalimumab (Humira) and ustekinumab (Stelara) both have FDA-approved biosimilars on the US market as of 2026, so a same-molecule switch within either drug family is often the easiest cost-saving move. Etanercept (Enbrel), secukinumab (Cosentyx), and risankizumab (Skyrizi) have no biosimilar competition in the US yet, so cost relief for those three depends entirely on Medicare negotiation status (Enbrel only), manufacturer copay cards for commercially-insured patients, or income-based patient assistance programs. The comparison table below lays out cash price, Medicare Part D treatment, biosimilar availability, and manufacturer patient assistance program for all five drugs side by side.
What Biologics Cost Comparison Costs by Point of Pay (2026)
The price you pay depends almost entirely on WHERE you pay. The same biologics cost comparison can cost many times more at a hospital than at your local pharmacy:
2026 Biologics Cost Comparison Price by Point of Pay
Where you pay
Typical cost
Notes
Pharmacy or specialty-pharmacy counter (retail, brand cash price)
$6,800 - $24,000, depending on drug and dosing interval
Humira brand runs $6,922/month; Enbrel and Cosentyx run $6,800 - $8,500/month; Stelara and Skyrizi run $11,000 - $24,000 per single dose at their 8-to-12-week dosing interval; see comparison table above for per-drug detail
Only Humira and Stelara have same-molecule biosimilar alternatives in 2026; Enbrel, Cosentyx, and Skyrizi have none
Medicare Part D (2026, IRA Maximum Fair Price where applicable)
$2,355 - $4,695/month for Enbrel and Stelara; formulary tier copay on full list price for Humira, Cosentyx, and Skyrizi
Enbrel and Stelara Maximum Fair Prices apply automatically at any network pharmacy through 2026; the other three drugs depend entirely on your plan's formulary tier
Commercial insurance with manufacturer copay card
$0 - $50/month copay
HUMIRA Complete, Enbrel Co-Pay Program, Stelara withMe, Cosentyx Connect, and Skyrizi Complete each cap commercially-insured copays; none of the five cards can be used with Medicare, Medicaid, TRICARE, or VA
Medicaid
$1 - $4/prescription
Most state Medicaid formularies require prior authorization and step therapy across all five biologics, often preferring a lower-cost TNF inhibitor or a biosimilar before approving Cosentyx or Skyrizi
Medicare IRA Maximum Fair Prices effective January 1, 2026 per CMS. Retail and biosimilar prices from GoodRx 2026 data. Medicaid cost-sharing varies by state; check your state's Medicaid income limits page for household eligibility rules.
Source: CMS IRA Negotiated Prices 2026, CMS Medicare Part D 2026 Benefit Parameters, GoodRx, manufacturer savings programs
Why Hospitals Charge So Much
Hospitals rarely bill any of these five biologics as a standalone pharmacy line item during a routine outpatient visit, because Humira, Enbrel, and Cosentyx are almost always self-injected at home. Stelara and Skyrizi are the two exceptions: both offer an intravenous (IV) loading-dose option for Crohn's disease and ulcerative colitis, administered in an infusion center or hospital outpatient department, which can bill at facility rates of $15,000 to $180,000 per infusion depending on the facility and dose. Private insurers negotiate their own bundled infusion rates separately from any single drug's retail price, and uninsured patients face the hospital's full chargemaster rate for that same infusion.
Medicare Part B covers the IV induction dose for Stelara and Skyrizi under HCPCS codes J3358 and J2327 respectively, paid at ASP plus 6%, while the ongoing subcutaneous maintenance dose for either drug typically shifts to Medicare Part D once the patient transitions to home self-injection. That Part A or Part B to Part D transition is where the 2026 IRA Maximum Fair Price for Stelara ($4,695 per 30-day supply) kicks in, along with standard Part D formulary tier cost-sharing for the drugs without a negotiated price. Patients discharged on a new biologic prescription without an active Part D plan often face sticker shock at the outpatient specialty pharmacy because they assumed the inpatient or infusion-center rate would carry over.
None of the five biologics has a small-molecule generic, so the cost-reduction pathway that lowers prices for drugs like Eliquis or metformin (ANDA generic competition) simply does not apply here. Cost reduction for Humira and Stelara comes from FDA-approved biosimilar competition under the Biologics Price Competition and Innovation Act; cost reduction for Enbrel and Stelara additionally comes from IRA Medicare negotiation; and cost reduction for Cosentyx and Skyrizi, which have neither biosimilar competition nor a negotiated price in 2026, depends entirely on manufacturer copay cards for commercially-insured patients or income-based patient assistance programs for everyone else.
HCPCS J-Codes: What Appears on Your Bill
Most use of these five biologics is self-administered at home and billed through Medicare Part D, not Part B. Part B HCPCS J-codes apply only when a clinician administers the drug in an office, infusion suite, or hospital outpatient department, most commonly for IV loading doses of Stelara or Skyrizi, or for patients who cannot self-inject:
Used only when a physician directly supervises the injection; standard home self-injections are billed through Part D instead.
J3357 / J3358
Injection, ustekinumab, subcutaneous (J3357) or intravenous (J3358), per 1mg (Stelara)
J3358 appears for the IV induction dose used in Crohn's disease and ulcerative colitis; J3357 appears for clinic-administered SC maintenance doses.
J2327
Injection, risankizumab-rzaa, intravenous, 1mg (Skyrizi IV induction)
Applies only to the 600mg IV induction dose for Crohn's disease or ulcerative colitis; the SC maintenance dose is billed through Part D.
J3247
Injection, secukinumab, intravenous, 1mg (Cosentyx IV loading dose)
Applies to the newer IV loading-dose formulation for ankylosing spondylitis and axial spondyloarthritis; most Cosentyx use remains SC self-injection under Part D.
HCPCS Level II codes are public domain, published annually by CMS. If you see one of these codes on a bill for a routine home self-injection, ask your provider to verify the claim, since most home self-administration should be billed through Part D, not Part B.
Source: CMS HCPCS Level II Coding, CMS Medicare Part B Drug Average Sales Price files
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AbbVie, Amgen, Janssen, and Novartis each run a separate patient assistance program for their biologic, and the income thresholds differ meaningfully across the four manufacturers. If you have no insurance and a modest income, your biologic may be free through the correct manufacturer program, but you must apply to the manufacturer of your specific prescribed drug; there is no single combined biologics assistance program.
Patient assistance programs for Biologics Cost Comparison
Manufacturer program
Cost / Benefit
How to apply
myAbbVie Assist (Humira and Skyrizi)
Free Skyrizi for uninsured patients with household income below approximately 600% FPL ($95,760 for a household of 1 in 2026); closing to new Humira applicants July 1, 2026
abbvieaccess.com/patient-assistance
Amgen Safety Net Foundation (Enbrel)
Free Enbrel for uninsured or underinsured patients below Amgen's income limits
amgensafetynetfoundation.com
Janssen CarePath / Stelara withMe (Stelara)
Free Stelara for uninsured or underinsured patients with household income below approximately 400% FPL
jnjwithme.com
Novartis Patient Assistance Foundation / Cosentyx Connect (Cosentyx)
Free Cosentyx for uninsured patients with household income below approximately 500% FPL
pap.novartis.com
NeedyMeds Drug Discount Card
Variable discount on any of the five biologics, accepted at most US pharmacies, no income limit
needymeds.org
Manufacturer savings cards for all five biologics (HUMIRA Complete, Enbrel Co-Pay Program, Stelara withMe, Cosentyx Connect, and Skyrizi Complete) are not available to Medicare, Medicaid, TRICARE, or VA beneficiaries by federal law (anti-kickback statute, 42 U.S.C. Section 1320a-7b). If you have any government insurance, use the manufacturer's income-based patient assistance program instead of a copay card, or apply for Medicare Part D Extra Help through Social Security at 1-800-772-1213.
Medicare Part D treats these five biologics very differently in 2026. Enbrel and Stelara are subject to the IRA Maximum Fair Price of $2,355 and $4,695 per month respectively, applied at any network pharmacy regardless of which specific plan you carry. Humira, Cosentyx, and Skyrizi have no negotiated price; your out-of-pocket cost depends entirely on your Part D plan's formulary tier, and most plans place adalimumab biosimilars on a much lower tier than brand Humira while placing full-price Cosentyx and Skyrizi on their highest specialty tier. All out-of-pocket spending on any of the five drugs counts toward the same 2026 Part D annual out-of-pocket cap of $2,100; once you hit that cap across all your Part D drugs combined, you pay $0 for the rest of the calendar year.
Extra Help (the Part D Low Income Subsidy) reduces cost-sharing further for Medicare beneficiaries with limited income and resources. In 2026, Extra Help enrollees pay $12.65 per fill for a brand-name biologic like Cosentyx or Skyrizi, and a smaller copay for a biosimilar like adalimumab-adbm or Wezlana. Extra Help is generally available to beneficiaries with income at or below 150% of the Federal Poverty Level. Apply through the Social Security Administration at 1-800-772-1213 or at ssa.gov, and mention which specific biologic you take since eligibility rules for the manufacturer PAP on top of Extra Help vary by drug.
Common Biologics Cost Comparison Billing Errors
Billing problems for these five biologics tend to show up on specialty pharmacy claims or hospital Explanation of Benefits statements rather than at a routine retail pharmacy counter. Watch for these issues:
Pharmacy charges more than the $2,355 Enbrel or $4,695 Stelara IRA Maximum Fair Price for a Medicare Part D fill in 2026, which violates federal law; ask your plan's member services to reprocess the claim.
Adalimumab or ustekinumab biosimilar billed at the brand-name price instead of its own lower ASP or Part D tier.
Manufacturer copay card applied for a patient who has Medicare or Medicaid, which is prohibited and can result in a claim clawback later.
Step therapy denial for Cosentyx or Skyrizi requiring a TNF inhibitor trial without documenting that the TNF inhibitor is clinically inappropriate or was already tried and failed.
IV induction dose for Stelara or Skyrizi billed under a J-code that does not match the specific drug administered, which can trigger an incorrect copay or coverage denial.
Charged the standard copay after you already hit the $2,100 Part D annual out-of-pocket cap for the year across all your combined Part D drugs.
Frequently Asked Questions
Is there a generic or biosimilar for Humira, Enbrel, Stelara, Cosentyx, or Skyrizi?
Yes for two of the five. Humira has more than 10 FDA-approved adalimumab biosimilars, 7 with the interchangeable designation, available since 2023 at $550 to $1,315 per month. Stelara has 5 FDA-approved ustekinumab biosimilars (Wezlana, Selarsdi, Steqeyma, Yesintek, Pyzchiva) that launched throughout 2025. Enbrel has two FDA-approved biosimilars blocked from the US market by patent settlements until approximately 2029. Cosentyx and Skyrizi have no biosimilar in any market status as of 2026, with core patents running through roughly 2028 to 2029.
How do I apply for a biologic manufacturer patient assistance program?
Apply to the manufacturer of your specific drug: myAbbVie Assist at abbvieaccess.com for Humira or Skyrizi, Amgen Safety Net Foundation at amgensafetynetfoundation.com for Enbrel, Janssen CarePath at jnjwithme.com for Stelara, or the Novartis Patient Assistance Foundation at pap.novartis.com for Cosentyx. Each requires proof of income, proof of US residency, a valid prescription, and documentation that you have no prescription drug coverage for that drug. Processing takes 7 to 15 business days, and approved patients typically receive a 12-month supply that requires annual re-enrollment.
Can I use a biologic manufacturer copay card with Medicare?
No. Federal anti-kickback law (42 U.S.C. Section 1320a-7b) bars Medicare, Medicaid, TRICARE, and VA beneficiaries from using any manufacturer copay card, including HUMIRA Complete, the Enbrel Co-Pay Program, Stelara withMe, Cosentyx Connect, and Skyrizi Complete. Medicare Part D patients on Enbrel or Stelara should instead rely on the 2026 IRA Maximum Fair Price ($2,355 and $4,695 respectively), and patients on Humira, Cosentyx, or Skyrizi should apply for Part D Extra Help or the matching manufacturer PAP if they cannot afford the formulary copay.
What if my insurance denies coverage for my biologic or requires step therapy first?
Request a written denial notice, then file a formal appeal within 60 days with a prescriber letter documenting medical necessity. If your plan requires step therapy with a cheaper biologic or biosimilar, your prescriber can file a step-therapy exception documenting contraindication, prior failure, or urgent risk such as rapidly progressing joint damage. If the appeal fails, apply for the manufacturer PAP that matches your specific drug as a fallback.
Does the IRA negotiated price apply to Humira, Enbrel, Stelara, Cosentyx, or Skyrizi?
It applies to two of the five. Enbrel and Stelara were both selected for Medicare's first round of Inflation Reduction Act negotiation, with Maximum Fair Prices of $2,355 and $4,695 per 30-day supply respectively, effective January 1, 2026. Humira was never eligible because biosimilar competition already existed before CMS finalized its Round 1 selections in 2023. Cosentyx and Skyrizi were not selected in Round 1 or in the 15-drug Round 2 list announced in January 2025 for 2027 effective prices, so both remain unnegotiated for the foreseeable future.
What does each biologic cost without insurance at the pharmacy counter in 2026?
Without insurance, Humira brand runs $6,922 per month while its biosimilars run $550 to $1,315 per month. Enbrel runs $6,800 to $7,500 per month. Cosentyx runs about $8,492 per month at list price. Stelara runs $11,000 to $17,000 per single injection at its 8-to-12-week dosing interval. Skyrizi runs $20,200 to $24,000 per single dose at its 12-week maintenance interval. Only Humira has broad discount-coupon availability across retail pharmacies; the other four are distributed through specialty pharmacy networks at close to list price without a manufacturer copay card.
Do I qualify for a biologic patient assistance program based on my income?
It depends on which drug you take, since each manufacturer sets a different income cutoff. myAbbVie Assist for Humira and Skyrizi generally requires household income at or below 600% of the Federal Poverty Level ($95,760 for one person in 2026). Janssen CarePath for Stelara uses roughly 400% FPL. The Novartis Patient Assistance Foundation for Cosentyx uses roughly 500% FPL. Amgen Safety Net Foundation for Enbrel sets its own separate income limits. Check the specific program for your prescribed drug rather than assuming one threshold applies to all five.
Which biologic is cheapest for autoimmune disease in 2026: Humira, Enbrel, Stelara, Cosentyx, or Skyrizi?
For uninsured patients without a manufacturer PAP, an adalimumab biosimilar (for Humira) is the cheapest at $550 to $1,315 per month, since it is the only one of the five with broad, mature biosimilar competition. For Medicare Part D patients, Enbrel and Stelara are often cheapest in practice because their 2026 IRA Maximum Fair Prices ($2,355 and $4,695) are capped by law, while Cosentyx and Skyrizi cost depends entirely on your plan's formulary tier for the full list price. Your prescriber, not cost alone, should guide which biologic is clinically right for your specific condition.
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