Stelara Cost: List Price Per Dose, Biosimilars, and Out-of-Pocket in 2026-2026

Most patients assume a $150,000-a-year drug means a $150,000-a-year bill. Wrong — and that misunderstanding causes a lot of needless panic. Stelara’s list price is roughly $25,000 per maintenance dose every 8 weeks, but the number you pay is almost never the number on the press release.

Stelara, the brand name for ustekinumab, blocks the IL-12 and IL-23 immune pathways and treats both Crohn’s disease and ulcerative colitis. The FDA approved it for Crohn’s in 2016 and UC in 2019. It’s one of the priciest specialty biologics in gastroenterology — and one where the gap between list price and real cost is enormous.

Stelara Cost Breakdown

Those big figures are Wholesale Acquisition Cost — the sticker before insurers negotiate. The IV loading dose at the start of treatment is weight-based and billed separately, often under your medical benefit rather than pharmacy.

The 2024-2025 Biosimilar Wave

Stelara lost its core patent protection, and ustekinumab biosimilars started reaching pharmacies in 2024 and 2025. Wezlana was among the first FDA-approved interchangeable versions. These aren’t generics, but the FDA holds them to a clinical-equivalence standard.

How Insured Patients Pay $0

Janssen CarePath is the manufacturer’s copay assistance program for Stelara. With commercial insurance, you typically pay your specialty-tier copay and the program covers nearly all of it — landing many patients at $0 to $5 per dose.

Two things can break that:

• Copay accumulator programs that stop counting card dollars toward your deductible.
• Switching to Medicare, where federal anti-kickback rules bar copay cards entirely.

If you’re on Medicare, the silver lining is the Inflation Reduction Act’s $2,000 annual out-of-pocket cap on Part D drugs, which took effect in January 2025. For a patient who used to face thousands in coinsurance, that’s a life-changing reduction.

Stelara for Ulcerative Colitis vs. Crohn’s

Stelara is approved for both conditions, and the cost structure is identical. If your diagnosis is UC, our broader ulcerative colitis medication cost guide walks through where Stelara sits among the alternatives. Many UC patients start on cheaper agents first — see mesalamine medication cost for the entry-level option insurers usually require you to try.

For Crohn’s patients weighing biologics against each other, the full class comparison lives in our Crohn’s disease biologic medication cost guide.

Prior Authorization and Step Therapy

Insurers almost never approve Stelara as a first-line drug. Expect step therapy: you’ll likely need to show that a cheaper conventional therapy, and often an anti-TNF biologic, didn’t work or wasn’t tolerated. Prior authorization typically requires a confirmed diagnosis with colonoscopy or biopsy documentation.

This is part of why GI care gets expensive fast — the diagnostics, the drugs, and the procedures all stack up. If you’re still trying to understand the procedure side, our explainer on why is colonoscopy so expensive covers the same opaque pricing dynamics that drive biologic costs.

The Bottom Line

Stelara’s $25,000-per-dose list price is real, but it’s a wholesale figure, not your bill. With commercial insurance and Janssen CarePath, most patients pay $0 to $5 a dose. On Medicare, the new $2,000 cap protects you. And the 2024-2025 biosimilar wave is finally putting downward pressure on a drug that had none for years. Before your first maintenance injection, get a written out-of-pocket estimate from your specialty pharmacy — and ask whether a biosimilar would cost you less.