Stelara® Medicare Coverage

Stelara®
Chemical name: Ustekinumab

Typical dosage: 90mg/ml

Typical type: Injection1

Stelara® is a medication typically used to treat Chron’s disease, plaque psoriasis and psoriatic arthritis. It is available as brand name only and is an IV or subcutaneous injection.

Stelara is a prescription medication that contains the active ingredient Ustekinumab.

Stelara is given either IV or subcutaneously into the fatty part of the skin. Stelara is given once every 4 to 12 weeks depending on the condition being treated.

Stelara binds to and reduces inflammatory substances in the body to improve Chron’s disease, plaque psoriasis and psoriatic arthritis.

The major side effects of Stelara include feeling tired or weak, headache, vomiting, nose and throat irritation, signs of a common cold and irritation where the shot is given.

Does Medicare cover Stelara?

Yes! 41% of Medicare Advantage plans and Medicare Part D plans cover Stelara.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Stelara.

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Average costs for Stelara with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$6,326 – $25,305 $6,326 – $25,305

Additional information

If you are using Stelara subcutaneously at home, the place on the body where you give the shot should be rotated each time you give it. If you have the solution for injection at home, store it in the refrigerator and make sure it does not freeze.

If the medication is given as an infusion, a healthcare provider will do it for you.

Stelara increases the risk of getting an infection. Stay away from people who are sick and be sure to wash your hands often. If you have any infection, are taking antibiotics now or in the recent past or have had many infections, talk with your doctor.

You should consult your doctor before getting any vaccines while taking Stelara. Vaccine use with this drug may either raise the chance of an infection or make the vaccine not work.

Stelara can increase the risk of certain cancers such as skin cancer. Have your skin checked often and tell your doctor if you notice any alarming changes.

Stelara has not shown increased risks in pregnant patients, but other agents are preferred in pregnant women for treatment of these conditions.

It is not known if Stelara is present in breastmilk, and patients should use caution while taking this medication and breastfeeding.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.