Stelara (J3358) cost and reimbursement per infusion

$10.249 per mg is Part B's ASP+6% rate for Q4 2026. At the 390 mg band (over 55 kg to 85 kg, the worked example on this page) the drug alone runs $3,997.11, and the patient's 20% coinsurance on the full claim (drug plus the 96365 administration line) is $812.85 once the $283 Part B deductible is met, with no annual out-of-pocket maximum to cap it. Full explanation: How Medicare Part B drug cost sharing works →

Medicare pays J3358 per 1 mg billing unit, not per vial or per dose. The 390 mg band is 390 billing units from three 130 mg vials, with no discarded drug, so JZ applies and JW never does at any adult band. The MUE for J3358 is 520 units per day, matching the top weight band (four vials); Anthem's own quantity rule for that band reads "4 vials (one time fill)."

One claim per course, not a repeating schedule

J3358 prices a single weight-banded induction infusion, not a recurring dose: the label sets no re-induction schedule, so there is one claim per course and no annual total to calculate. The 260 and 520 mg bands above are the drug line only, priced at the same $10.249 per mg rate as the 390 mg worked example.

Eight weeks after the infusion, and every 8 weeks after that, the patient moves to 90 mg subcutaneously: a prefilled syringe billed J3357 per 1 mg in the office, unpriced this quarter, or filled on the pharmacy benefit. That dose never appears as a J3358 or 96365 claim line here.

For the reference patient — 390 mg (the over 55 kg to 85 kg band), 390 units, drug plus the 96365 administration code — Medicare allows $4,064.25, and the Part B coinsurance on that is $812.85. Plans A, B, C, D, F, G, M and N cover that coinsurance in full, so those patients owe nothing on the claim once the $283 deductible is met. Plans K and L do not. Because the induction infusion is billed once, what a Plan K patient owes on this claim depends on whether the deductible has already been met for the year: $661.12 if it has not, $406.42 if it has. See what each Medigap plan (A–N) owes on this claim →

Only the letters that leave this patient a balance are listed. The full A–N grid, the high-deductible variants, Plan N’s office-visit carve-out and the MACRA restriction on Plans C and F are at Medigap Plans A–N.

Payers negotiate their own rate for J3358, not ASP+6%. Our corpus holds published rates from 37 of 37 payer files, and Aetna's all-states median is $12.56 per unit, putting the 390-unit worked example at $4,898.40 before benefits. That rate differs by payer and state, and it is not what the patient actually pays either; their own plan benefits set that number, and 17 of the corpus's 29 ustekinumab payers also name a preferred product, which decides which code the claim can even carry. Full explanation: How commercial drug reimbursement works →

These three price under the same ASP+6% mechanism as Stelara, but at a different rate and a different labeled dose, so the rate alone doesn't translate into a comparable per-infusion total. Nearly every payer in the coverage corpus requires a conventional therapy trial first, and 27 of 29 ustekinumab payers require another product first, usually a conventional agent and increasingly a preferred ustekinumab product. See which payers require what →

Seven products compete with Stelara at their own ASP+6% rate this quarter, from less than a quarter of its rate to slightly above it. At the 390-unit worked example, the spread runs from $886.47 to $5,165.94 against Stelara's $3,997.11.

None of the seven biosimilars has a manufacturer or foundation program on file. The rate a practice can even bill often isn't the practice's choice: 17 of 29 ustekinumab payers name a preferred product, and the preferred product varies by payer. BCBS Michigan prefers Yesintek IV; CareFirst keeps Stelara IV itself on its preferred list. Submitting the wrong code for a given payer risks an administrative denial rather than a reimbursement question. See each payer's preferred product →

On a commercial plan, the Janssen CarePath Savings Program brings the drug cost down to $5 per dose, up to $20,000 a year, and it covers the drug line only; the 96365 administration is billed separately and isn't part of the program. It excludes Medicare, Medicaid, TRICARE, VA and other government insurance. The Johnson & Johnson Patient Assistance Foundation, the free-drug program for uninsured patients, closed on June 14, 2026.

No open inflammatory bowel disease foundation fund is on file that this claim can draw on: TotalAssist's Ulcerative Colitis fund (formerly PAN) is closed as of September 7, 2026. HealthWell's ANCA-Associated Vasculitis fund is open, but it doesn't apply here; vasculitis isn't a Stelara IV indication. That leaves a Medigap plan as the only route to $0 on Medicare today. See every program for this patient, with current status →

None of the seven ustekinumab biosimilars carries a program record of its own, so switching products to chase a lower ASP+6% rate doesn't open a new source of assistance; the CarePath card is specific to branded Stelara.

Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (96365, 99214, national non-facility); Medicare Part B deductible (2026); Medicare Rights Center 2026 Medigap plan benefits chart; 37 commercial payer published price files (Q2 2026); Janssen CarePath Savings Program terms (jnjwithme.com/patient/stelara/cost-support); HealthWell Foundation and PAN Foundation fund status, verified Sep 7, 2026.

Reviewed September 21, 2026 by Erin Rose, CareCost Estimate founder. Methodology →