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Cost of Stelara

I am not using Stelara. However, I did a quick search for patient assistance programs, and it appears that the company offers a few. Info is on the Stelara website.

Are you currently on Stelara, or are you going to be starting it soon? I'm actually really interested in it's use for IBD. I'm wondering about possibly mentioning it to my GI as a treatment option for myself.
 
I have an appointment with my GI on the 13th of February to talk over the results from my visit with a specialist. One of the recommendations was for me to switch from Remicade to Stelara."

2
 
In Alberta it is 4465.58 per dose. (Not including any pharmacy mark up) So pretty expensive. I did some research when considering this drug (currently I'm trying Remicade and methotrexate) and it is made by the same company as Remicade and they have an assistance program (Bioadvance in Canada) that I'm assuming is very similar to the one for Remicade.
 
Also, it depends of the dose. I have 90 mg, and I think it's that for most of the people with Crohn, but just be careful, because someone who uses Stelera for psoriasis might tell you a smaller cost, because often their dose is 45 mg.

But as it's been said, in Québec, and Canada I suppose, BioAdvance offers a very good assistance program. For the fees but also for the patient. They do a great job.

Do you plan to start Stelara soon or Remicade seems to work so far?
 
I would also check with your insurance. I know that my insurance does not cover Stelara for Crohn's as it is "not approved for the treatment of Crohn's". According to my insurance Stelara is only approved for the treatment of Psoriasis. There is a chance that without fighting with them, they will not approve it for you..
 
My doctor wants to start me on Stelara; this is my first biologic. I've been taking Entocort for a while.

I'm on SS disability & have Medicare A, B D.

I just talked to the nurse at the infusion center & she said my co- pay for Stelara is $3,300.00 but that there was an assistance program that would reduce my co- pay to $5- $15 if I qualify.

I just went to the Stelara website & it says patients with Medicare are not eligible for the co- pay savings card.

So what am I supposed to do? Of course I can't pay $3,300 per dose - - who could?

I had gotten my hopes up that I was finally going to get treatment that will make me feel better, & this information just crushes my hopes...

I'm 55 years old & my goal is/was to get the Crohn's under control and get to a point that I felt better & good enough to go back to work, at least part time, hopefully full time!

I know I can't be the only one with Medicare who needs biologic medication. What did you do about the cost & not qualifying for the co- pay assistance because you have Medicare drug coverage?

I would appreciate any experiences &/or advice or suggestions...I feel completely hopeless now of ever getting better.

Thank you,

Dana B
Lufkin, TX
 
I'm on Medicare and have united healthcare advantage. I was told it would cost me $1400. for loading infusion and injections cost &10,000. I can't afford that either. I was very disappointed. I have taken three biologic and I'm not on any meds for Crohns at this time. I'm doing ok but I do have active Crohns. Dr is trying to get me approved now for Entyvo.
 
I was the biggest cheerleader for Stelara since I participated in the clinical trials in 2006. Been waiting all these years for it since I have been through Humira, then Entyvio, then Remicade.

Even went on a consultation in 2016 with one of the worlds expert in Stelara, Dr Gil Melmed, which led the UNITI 2 study of Stelara that had 297 patients. I was so excited to finally getting to FDA approval.

Had the infusion and experienced very good results. I went through several phone numbers, was in constant touch with the Stelara nurse navigator, tried multiple ways to get in the patient assistance program. Rejected at every point since I was on Medicare and was also exceeding the maximum income and they counted my wife's pension as well.

I tried starting with the injection being given by a nurse at the hospital. The infusion center did not want to do injections, eventually I found the nurses that will go to your home to give injections. The hospital was going to order the injections, the specialty pharmacy was quoted with a 20% I needed to pay at $26000 for six injection pack (I could buy a new car every year at these prices). These injections need to be refrigerated to last a whole year. If you are new to Stelara and find after a few injections that it is not working, you are stuck with the rest.

Now I am using BriovaRX and injecting at home. The first injection was $3680! and the rest are $1200 each with Medicare limits. That comes to $9,600 a year, I still cannot afford it but it is my only choice at these point.(any other ideas ?)

My suggestion that are new to this is to get quotes on Humira, then Entyvio(did not work for me), your out of pocket costs are lower than the outrageous Stelara costs.
 
Even though Stelara is expensive, I have found that it works very well and with minimal to no side effects. I think the price of Stelara is well worth it. Hopefully there will be generics of stelara sometime soon.
 
As of yesterday, when the initial infusion was conducted,the total cost for the three doses was approx Aud $12,500. Fortunately, because of DVA ( veterans affairs) status , the cost to me was just $6.90! Other Private prescriptions cost AUD $39- so we are very fortunate once we have been accepted on this government sponsored scheme.

As Stelara has only recently been placed on the Australian Pharmaceutical Benefits Scheme, one had to go through the hoop to to be accepted as a new patient. By this I mean 3 months of Entocort, 6MP and Methotrexate, even though they have proved ineffective before.

I really feel for people that have private insurance and are get precious little back from their insurers.

For for those who have to pay the full cost for US and Canadian comparisons here is the equivalent price of s single 45 mg injection.
OZ USA CAN
$4693 USD $3626 CD$420

For UK conversion, divide the Aussie dollar by two-close enogh!

Hopefully, Stelara will work! I don't fancy another surgical resection of a metre of ileum at my age- this being on the cards.

Will wait and see and drop a post later. Fingers crossed.
Cheers,
Merv
 
I just got the bill for the January infusion.

Total billed to the insurance company $17,207
My copay is $492.48
This counts to my $2200 maximum.

This means that the infusion is LESS than one syringe and is about 4 times the quantity.

Maybe they are trying to get you on Stelara, if it works, then they sock it to you with the syringes.

I wish there was a way to order the infusion and get on it but only put in a fourth the quantity and save the bag for later...
 
It is shocking how expensive Stelara is.

When I had a physical with my primary care doctor, I mentioned I was moving to Stelara. He cracked some jokes about it's cost, but I hadn't received a bill yet, and I figured, oh well, all these biologics are expensive.

Cimzia, which I was on for 5 years, was something like $3800 a month.

I know Humira is in the same ballpark. I figured that Stelara, with half the frequency of injections, might be twice as much as Cimzia, so somewhere around $7500-8000.

I just about gagged when I saw the explanation of benefit from my insurance company. They paid $22,000 for a single, small syringe! And that is the negotiated rate!

I can't believe they approved Stelara without requiring that I fail all anti-TNFs and Entyvio first.
 
Yeah, when I look at my bill it is pretty crazy how much they pay for stelara. However, I think there might be some form of rebates for the insurance companies. The pharmaceutical industry is a lot more complicated than meets the eye. There are so many complicated rebates/refunds to insurance companies and manufacturers that just by looking at the insurance payout might not show the whole picture.
 

my little penguin

Moderator
Staff member
Ds was on humira for over five years prior to switching to Stelara
The cost of humira when taken at the higher frequency can be high as well


Price paid and negotiated price is very different
Especially in the hospital procedures
That’s why certain “brands” of drugs are preferred
And the preferred “brand” can change from one year to the next

For ds it works
 
Yes, stelara works. And even though it is debatable somewhat, I think stelara is a much safer drug, which is why I chose it first line. It is more specific and functions downstream in the biomolecular level. I would say that immunosuppressive therapy is on a spectrum. Prednisone is like a jackhammer, humira is like a regular hammer, and stelara is like a chisel.
 
My Stelara treatment consists of a 390 mg loading dose administered by infusion. After that, I receive a 90 mg maintenance dose every 8 weeks administered by self injection. I had the infusion several weeks ago and will have my first maintenance dose in about two weeks.
I'm with Blue Cross Blue Shield. The billing for the infusion is complete. The numbers reported to me were $13,474 "retail" vs $8,448 "negotiated". My insurance covered 80% of the "negotiated" and I'm responsible for the remaining 20%.
I've had several discussions with the specialty pharmacy that is supposed to supply the injections. I'm told the "negotiated" cost is $20,674 per injection. Thus, a huge cost discrepancy between the 390 mg loading dose and the 90 mg maintenance dose.
Causes me to think I'm not getting correct information from the customer service rep's that answer the phone.
Any veteran Stelara users out there that can shed some light?
 

my little penguin

Moderator
Staff member
Trebor-Hi
Have you signed up for the Stelara support card ?

https://www.stelarainfo.com/janssen-carepath

That will cover a lot of your 20% as well as your co pay on the maintenance

Most insurances the copay goes against your out of pocket max
So eventually you no longer have a copay during the year

A single syringe is around $22 k per goodRX

But insurance does cover the majority
With the extra picked up by Jansen care path program
Make sure to sign up
 
I second signing up for the Janssen Carepath program. I get my Stelara injections for only a $5 copay every eight weeks.
 
Yes, I'm signed up for Janssen's Co-pay assistance program.
I'm interested in what the insurance companies are paying for our Stelara treatment. The so called "negotiated cost". Both for the loading dose administered by infusion and the maintenance doses administered by self injection.
 
With all this talk about the cost of the various biologics, I found out two things this week:

1. Humira now costs $4700 a month for two shots. When I started on it five years ago it was $3200. IMHO this is highway robbery on a world wide scale.

2. I was just today approved by Abbvie's Patients Assistance Fund. This is obviously great news and a possible nightmare avoided after my retirement. I was ready to switch to an infusible biologic.

3. When you get close to retiring ask your GI's nurse to help you through the process of applying. I've been worried about it for years, but the nurse made it a lot easier and mostly painless.
 
Well Jack,
All I can say is that it seems that you are being comprehensively ripped off. By today's exchange rates, under a government scheme ( Public benefits-PBS) Stelara costs AUD $4348 for two 45 mg injections. That amounts to USD $3155 -a difference of USD 1545!

Personally, I pay only OZ $6.90 for the 2/12 injections which are part financed by Jannsen.glad to know that you have secured approval for assistance from your fund. The highest amount that an individual would pay in Australia , if not as I am in receipt of a vets pension the max I would pay is AUD$39 per prescription. I know we are talking about two different medicines, but I do have sincere sympathies with those in America that are being taken to the cleaners big time!
Regards.
Merv
 
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Lynda Lynda

Senior Member
With all this talk about the cost of the various biologics, I found out two things this week:

1. Humira now costs $4700 a month for two shots. When I started on it five years ago it was $3200. IMHO this is highway robbery on a world wide scale.

2. I was just today approved by Abbvie's Patients Assistance Fund. This is obviously great news and a possible nightmare avoided after my retirement. I was ready to switch to an infusible biologic.

3. When you get close to retiring ask your GI's nurse to help you through the process of applying. I've been worried about it for years, but the nurse made it a lot easier and mostly painless.
Jack, I was diagnosed with Crohn's In April 2018. I am disabled and collect SSD benefits and live on a fixed income.

My doctor got my paperwork started right away for my Humira. I was assigned a Humira Nurse Ambassador who came to my apartment and explained the application process and provided me with paperwork and instructions, without her I would have no idea what to do. I completed my part of the paperwork required to apply to the Patient Assistance Foundation. My doctor also completed some paperwork. All paperwork was faxed to the Patient Assistance Foundation from the fax machine at my doctors office. I was approved. I was approved for six months. Once I was approved I called AbbVie to set up a delivery date. AbbVie mailed me my first three month supply. After I received my Humira, my Humira Nurse Ambassador came to my apartment to show me how to use the Humira Injection Pens. She even gave me some materials to help me track my injection dates, when to reorder, etc.....she also calls me up to see how I am doing. I have regular visits to my Gastroenterologist and blood draws to monitor how everything is going. I have taken the Humira for 3 months.

I wish you the best of luck and I hope you don't have to worry for too much longer. Hope you feel better soon.

Lynda
 
Just to follow-up on my earlier post. The eligible charge for the Stelara infusion and injection were $8,998 and $7,061 respectively. The Stelara was provided by the hospital pharmacy and both the infusion & the injection were administered by the hospital infusion center.
When I inquired about having the drug supplied by a specialty pharmacy so I could self administer, I was told the eligible charge was $20,674. The insurance co.'s customer service people offered no explanation about the discrepancy. The specialty pharmacy suggested that perhaps the hospital gets a "volume discount".
I'm signed up for the co-pay assistance and further my max out of pocket is $3 grand. So, its not my pocket that's hurting. Still, hate to be part of the reason why insurance premiums are so high.
 
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