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Cost of stelara?

See the DrugPatentWatch profile for stelara

What is Stelara?

Stelara (ustekinumab) is a biologic medication used primarily for moderate‑to‑severe plaque psoriasis, psoriatic arthritis, and ulcerative colitis. It is a monoclonal antibody that targets interleukin‑12 and interleukin‑23, interrupting the inflammatory cascade that drives these conditions.

1. Typical Cost Range (U.S.)

Metric Approximate Cost
List price (Manufacturer’s price) $10,000–$15,000 per 90‑day supply (depending on dose)
Average wholesale price (AWP) $8,000–$12,000 for a 90‑day course
Average retail cost (out‑of‑pocket) $1,500–$3,000 per 90 days for patients without insurance
Typical co‑payment / deductible $100–$2,000 per 90 days, depending on plan (often a fixed copay or a 20%–30% coinsurance after meeting a deductible)

Why the range?
• Dose – Stelara is titrated: 45 mg, 90 mg, 180 mg, 210 mg, or 280 mg, depending on weight and disease.
• Insurance tier – Some plans place it in a high‑tier specialty drug category, which can increase patient cost.
• Location & pharmacy – Prices can vary by pharmacy, pharmacy benefit manager (PBM), and state.

2. Factors That Influence Your Out‑of‑Pocket Cost

Factor How It Affects Cost
Insurance coverage Most commercial plans cover Stelara, but often require a prior authorization, step‑down therapy, or a “step‑in” tier.
Deductible & Coinsurance After your deductible is met, you typically pay a copay or a percentage (e.g., 20–30%) of the drug’s price.
Formulary tier High‑tier placement means higher copays (sometimes $1,500+ for the first 90 days).
Manufacturer’s Patient Assistance Program (PAP) Eli Lilly offers a program for patients who meet income criteria (e.g., < 250 % of the federal poverty level).
State Medicaid Medicaid coverage often negotiates lower prices or covers the drug outright, but eligibility varies by state.
Retail vs. Mail‑Order Some plans give a discount for mail‑order pharmacy fills, but this can also increase the upfront cost if you’re not eligible for the discount.
Generic or Biosimilar availability As of 2024, no generic or biosimilar for ustekinumab is approved, so prices remain high.

3. How to Find Your Exact Cost

  1. Ask Your Provider – Your prescriber can request the drug’s “real‑world cost” through their pharmacy or PBM.
  2. Use Online Cost Calculators – Tools like GoodRx, RxSaver, or the manufacturer’s website allow you to enter your insurance details and get a personalized estimate.
  3. Check Your Pharmacy’s “Cost‑Share” Page – Many retail pharmacies (CVS, Walgreens, etc.) display a cost‑share calculator on their websites.
  4. Call the Pharmacy Benefit Manager – If you have a PBM (e.g., OptumRx, Express Scripts), they can provide exact copay amounts.

4. Reducing the Financial Burden

Option What It Is How It Helps
Patient Assistance Program (Eli Lilly) Grants medication for qualifying patients with no or low income. May cover 100% of the drug’s cost.
Manufacturer Discounts Manufacturer‑direct discounts for patients with certain insurance plans. Reduces the copay or coinsurance.
Co‑pay Cards Third‑party cards that offset copay amounts. Often covers a fixed amount (e.g., $300) per prescription.
Alternative Therapies Other biologics (e.g., adalimumab, ixekizumab) or non‑biologic systemic agents. May be cheaper or have lower copays under your plan.
Clinical Trials Participation in a trial can provide free medication. You receive the drug at no cost (though you must meet eligibility criteria).

5. Quick Reference

Item What to Check Where to Get It
Your copay Ask the prescriber or pharmacist Prescription label / insurance portal
Eligibility for PAP Income & insurance status Eli Lilly Patient Assistance website
Alternative drugs Look at your plan’s formulary Your insurer’s website
Cost calculators Insurance details, plan ID GoodRx, RxSaver, or your insurer’s portal

Bottom Line

Stelara is an expensive specialty medication, but the actual amount you pay can vary widely based on your insurance, dosage, and eligibility for assistance programs. The best first step is to check with your prescriber and pharmacist, use an online cost calculator with your insurance info, and explore the patient assistance program offered by Eli Lilly. If you’re still struggling, ask your provider about comparable, potentially less costly biologics or systemic therapies.



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