What Your Prescriptions Cost
How much does Stelara cost with Medicare in 2026?
Last reviewed: · Big Sioux Benefits Data Desk
Stelara has a Medicare-negotiated price of $4,695 for a 30-day supply as of January 1, 2026, down from a list price of $13,836, a 66% reduction (CMS, Negotiated Prices for Initial Price Applicability Year 2026). Only about 23,000 Medicare beneficiaries used it in 2023, the second-smallest group among the ten negotiated drugs, yet it still generated $3.0 billion in Part D gross covered drug costs.
The qualifier: at this price, the drug's cost and your cost have almost nothing to do with each other. One fill costs more than twice the entire annual out-of-pocket cap. You will clear the deductible and the cost-sharing phase during the first two fills and then pay $0 for covered drugs for the remaining ten months of the year, no matter how expensive the drug is.
How the year plays out
| Month | What you pay | Running out-of-pocket total |
|---|---|---|
| 1 | $615 deductible, then 25% of the rest | About $1,635 |
| 2 | The remainder up to the cap | $2,100, cap reached |
| 3 through 12 | $0 for covered drugs | $2,100 |
How this illustration is built: the 2026 standard Part D benefit, meaning a full $615 deductible, then 25% coinsurance, then $0 once your out-of-pocket total reaches $2,100. Your plan may use copays instead of coinsurance, may charge a smaller deductible or none, and may place the drug on a different tier, so treat this as the shape of the year rather than a quote. We are not showing plan-specific copays because we will not publish a number we cannot source.
Two practical notes for anyone on a drug in this range. First, prior authorization is close to universal for specialty biologics, so expect it and build in time rather than treating it as a denial, covered in prior authorization for Medicare drugs. Second, because essentially your entire annual drug cost lands in January and February, the Medicare Prescription Payment Plan is worth setting up before the year starts rather than after the first bill arrives.
Sources
- CMS — Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026 — prices effective January 1, 2026; accessed 2026-08-21
- CMS — Announcement of Calendar Year 2026 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (Part D benefit parameters) — CY2026 parameters; accessed 2026-08-21
- Medicare.gov — Costs for Medicare drug coverage — accessed 2026-08-21
Related questions
Is Stelara covered under Part D or Part B?
It depends on how it is administered. Self-administered injections generally fall under Part D, while a dose infused or injected by a professional in a clinical setting is generally billed under Part B, which uses 20% coinsurance and has no annual out-of-pocket maximum in Original Medicare. That distinction can change your cost dramatically, so confirm which applies to you.
Does the negotiated price mean my plan must cover Stelara?
No. Negotiation sets a maximum fair price for the drug; it does not require any particular plan to include it on its formulary or waive its utilization management rules. Coverage, tier placement, and prior authorization remain plan decisions.
Drug costs turn on your specific prescriptions, so the arithmetic is worth doing once, properly: book a free, no-pressure conversation, see your county's South Dakota plan lineup, or browse all answers. SHIINE, the state's free counseling program, is at 1-800-536-8197 and sells nothing.
Big Sioux Benefits is a licensed insurance agency, not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Contact Medicare.gov, 1-800-MEDICARE, or SHIINE (South Dakota's SHIP) for all of your options.