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Stelara Part D coverage 2027

Stelara is a brand of ustekinumab. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.

Coverage at a glance

In 2027, 133 of 5,492 Medicare Part D and Medicare Advantage drug plans (2.4%) list Stelara on their formulary, across 36 of 286 formularies. The most common placement is tier 5 (122 plans, 91.7% of those covering it). 133 of the covering plans require prior authorization (100%), 0 step therapy and 126 a quantity limit.

What a 30-day fill costs

10 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 10 of them $0; 123 charge coinsurance instead — median 28% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.

Stelara has a Medicare negotiated price (maximum fair price) of $4,695 for a 30-day supply, which applies. The negotiated price lowers what the plan pays; the member's copay or coinsurance still follows the plan's tier.

What changed since 2026

2026: 3,646 of 5,496 plans covered it (66.3%); 2027: 133 of 5,492 (2.4%).

Of 4,367 plans offered in both years, 6 added it to the formulary and 2,830 dropped it.

Among plans covering it both years, 1 moved it to a higher tier and 1 to a lower one; 0 added prior authorization and 0 removed it.

Tier placement

By plan type

By carrier

By state

Medicare usage

Medicare Part D paid for 230,577 30-day fills of Stelara in 2024 for about 24,746 enrollees, at an average total cost of $14,129.73 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).

Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.