What Does Stelara Cost in 2026 After Medicare Price Negotiation?

Stelara (ustekinumab) treats plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis by blocking two proteins (IL-12 and IL-23) that drive inflammation. Before the IRA negotiations, a single 90 mg subcutaneous injection listed at roughly $13,000 to $17,000, making it one of the most expensive specialty drugs in the Medicare Part D formulary. The 2026 Maximum Fair Price of $4,695 per 30-day equivalent supply represents the largest proportional savings Medicare has obtained across the first 10 negotiated drugs.

For Crohn's disease and ulcerative colitis, treatment begins with an intravenous induction dose given in a hospital or infusion center, followed by subcutaneous maintenance injections every 8 weeks. The IV induction dose (up to 520 mg depending on body weight) is billed under Medicare Part B using J3358 and can trigger a facility charge of $15,000 to $35,000 before insurance. The subcutaneous maintenance doses are typically billed under Medicare Part D. Patients with commercial insurance should check whether their plan covers the IV induction under medical or pharmacy benefits, as this affects their cost-sharing significantly.

Nine ustekinumab biosimilars have launched in the US market as of 2025, including Wezlana (Amgen), Selarsdi (Teva/Alvotech), Steqeyma (Celltrion), Yesintek (Biocon Biologics), and Pyzchiva (Sandoz), with list prices 80 to 92 percent below Stelara. By 2026, CMS announced Stelara will exit the IRA negotiated price list in 2027 because biosimilar competition is expected to drive prices lower than the negotiated MFP. Patients currently on Stelara should ask their prescriber whether a biosimilar substitution is clinically appropriate and check their plan's formulary for biosimilar coverage tiers.

What Stelara Costs by Point of Pay (2026)

The price you pay depends almost entirely on WHERE you pay. The same stelara can cost many times more at a hospital than at your local pharmacy:

Why Hospitals Charge So Much

For Crohn's disease and ulcerative colitis, the IV induction dose of Stelara (260 to 520 mg depending on body weight) is administered in a hospital or infusion center. At the Medicare ASP rate of $12.99 per mg, a 520 mg induction dose costs Medicare approximately $6,755 for the drug alone before the standard 6% add-on. But hospital chargemaster rates for the same infusion can list at $15,000 to $35,000, a 2x to 5x markup over the drug acquisition cost, because the facility charge bundles nursing time, IV supplies, infusion monitoring, and overhead.

Medicare Part B covers the IV induction dose under the buy-and-bill model: the hospital or infusion center purchases the drug, administers it, and then bills Medicare directly at ASP + 6%. The patient pays 20% coinsurance after the $283 Part B deductible in 2026. On a 520 mg induction dose at ASP pricing, patient 20% coinsurance would be approximately $1,351, not the chargemaster list amount. If you receive an Explanation of Benefits showing a much higher figure, that reflects the difference between the list charge and what Medicare actually paid.

Subcutaneous maintenance injections (45 mg or 90 mg every 8 weeks) are typically self-administered at home and billed under Medicare Part D, making them subject to the 2026 IRA Maximum Fair Price of $4,695 per 30-day supply equivalent. At the $2,100 annual Part D out-of-pocket cap effective in 2026, most Medicare Part D enrollees will hit their cap within a single injection cycle and owe nothing further for the rest of the year.

HCPCS J-Codes: What Appears on Your Bill

Ustekinumab appears on hospital and clinic bills under two HCPCS Level II J-codes. These codes are public domain and you can use them to verify exactly what you were billed:

Patient Assistance Programs

Johnson & Johnson offers two distinct programs for Stelara cost assistance, one for commercially insured patients and one for uninsured or underinsured patients. Amgen also offers a $0 copay program for patients receiving the biosimilar Wezlana:

Medicare Part D

Subcutaneous Stelara maintenance doses are billed under Medicare Part D. Under the 2026 IRA Maximum Fair Price, Medicare Part D enrollees pay no more than $4,695 for a 30-day supply of ustekinumab. Because the 2026 Part D annual out-of-pocket cap is $2,100, most patients will reach their annual cap after one or two injections and pay nothing further for the rest of the calendar year. Patients who qualify for Part D Low Income Subsidy (Extra Help) may pay significantly less.

Note that the IRA Maximum Fair Price applies only to Medicare Part D claims for approved indications. Patients with commercial insurance, Medicaid, or no insurance do not receive the MFP directly, but may benefit from biosimilar competition (biosimilars list at 80 to 92 percent below Stelara) or patient assistance programs. CMS has confirmed Stelara will exit the IRA negotiated price list in 2027 as biosimilar competition is expected to drive market prices even lower than the $4,695 MFP.

Common Stelara Billing Errors

Ustekinumab billing is complex because the drug spans both Part B (IV induction) and Part D (subcutaneous maintenance). These are the most common errors to look for on your bill:

• Wrong J-code: J3357 (subcutaneous) used for an IV infusion, or J3358 (IV) used for a self-administered subcutaneous dose. This shifts the billing between Part B and Part D and can incorrectly inflate or reduce the claim.
• Unit count error: J3358 is billed per 1 mg, so a 520 mg induction dose should show 520 units. A line showing 26 units (one vial) instead of 520 units (full dose) underbills; a line showing 1,040 units overbills. Verify the unit count matches your physician's prescribed dose.
• Biosimilar substituted but billed as brand: if you received Wezlana or another biosimilar but the bill shows J3357/J3358 at Stelara brand prices, the facility may be billing at the wrong acquisition cost. Biosimilars have their own Q-codes (e.g., Q9998 for Selarsdi) and lower ASP rates.
• Part B vs Part D misrouting: subcutaneous home-administered doses billed under Part B (J-code) instead of Part D, forcing you into the 20% Part B coinsurance structure instead of the Part D MFP or plan cost-sharing.
• Duplicate infusion administration charge: the facility bills both a drug line (J3358) and a separate supply/administration fee that together exceed the ASP+6% Medicare allowable. Request an itemized bill to identify both lines.

Frequently Asked Questions