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Stelara is a brand of ustekinumab. What agents check before quoting it: how many 2026 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2026, 3,646 of 5,496 Medicare Part D and Medicare Advantage drug plans (66.3%) list Stelara on their formulary, across 186 of 328 formularies. The most common placement is tier 5 (3,495 plans, 95.9% of those covering it). 3,546 of the covering plans require prior authorization (97.3%), 4 step therapy and 3,495 a quantity limit.
47 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $0, 46 of them $0; 3,599 charge coinsurance instead — median 25% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,100 in 2026, 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.
2025: 4,504 of 5,631 plans covered it (80%); 2026: 3,646 of 5,496 (66.3%).
Of 4,368 plans offered in both years, 144 added it to the formulary and 814 dropped it.
Among plans covering it both years, 21 moved it to a higher tier and 10 to a lower one; 0 added prior authorization and 69 removed it.
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).
Price Stelara and the rest of a client's list on every plan in their county.
Estimate Stelara costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
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 09/16/2026). CMS formulary data.