Medicare Part D coverage · 0.5 · RxCUI 1654079
0.5 ML ustekinumab 90 MG/ML Injection [Stelara]
Per the CMS 2026 Part D formulary file, 0.5 ML ustekinumab 90 MG/ML Injection [Stelara] is covered by 3,672 Medicare Part D plans (72.7% of enrollable products), averaging Tier 4.2, with prior authorization required on 99% of covering formularies.
- 72.7%
- Plan coverage
- 3,672
- Plans covering
- T4.2
- Avg tier
- 99%
- Prior auth required
What the CMS Formulary Data Shows for 0.5 ML ustekinumab 90 MG/ML Injection [Stelara]
Per the CMS 2026 Part D formulary file, 0.5 ML ustekinumab 90 MG/ML Injection [Stelara] (RxNorm concept RXCUI 1654079, generic name 0.5) appears on 193 distinct formulary files spanning 3,672 Medicare Part D plan offerings - 72.7% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.2.
Real-world access to 0.5 ML ustekinumab 90 MG/ML Injection [Stelara] depends on utilization management as much as tier placement: 99% of covering formularies require prior authorization. 0.5% require step therapy. 92.7% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.5 ML ustekinumab 90 MG/ML Injection [Stelara] today.
Coverage Details
- Formularies covering
- 193
- Plans covering
- 3,672
- Coverage rate
- 72.7%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 99% of formularies
- Step therapy required
- 0.5% of formularies
- Quantity limits
- 92.7% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 0.5 ML ustekinumab 90 MG/ML Injection [Stelara]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | Yes | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | Yes | $4.80 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 0.5 ML ustekinumab 90 MG/ML Injection [Stelara] covered by Medicare Part D?
Yes, 0.5 ML ustekinumab 90 MG/ML Injection [Stelara] is covered by 3,672 Medicare Part D plans (72.7% of all Part D formularies).
What tier is 0.5 ML ustekinumab 90 MG/ML Injection [Stelara] on Medicare Part D plans?
0.5 ML ustekinumab 90 MG/ML Injection [Stelara] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does 0.5 ML ustekinumab 90 MG/ML Injection [Stelara] require prior authorization?
99% of Part D formularies require prior authorization for 0.5 ML ustekinumab 90 MG/ML Injection [Stelara]. Step therapy: 0.5%. Quantity limits: 92.7%.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- amikacin liposomal 70.3 MG/ML Inhalation Suspension [Arikayce] T4.2
- cannabidiol 100 MG/ML Oral Solution [Epidiolex] T4.2
- fecal microbiota spores, live-brpk 30000000 UNT Oral Capsule [Vowst] T4.2
- fenfluramine 2.2 MG/ML Oral Solution [Fintepla] T4.2
- ganaxolone 50 MG/ML Oral Suspension [Ztalmy] T4.2
- ibrutinib 140 MG Oral Capsule [Imbruvica] T4.2
Similar prior-authorization rate
- 3 ML liraglutide 6 MG/ML Pen Injector 99% PA
- 500 ML soybean oil 200 MG/ML Injection [Nutrilipid] 99% PA
- edaravone 21 MG/ML Oral Suspension [Radicava] 99% PA
- 3 ML icatibant 10 MG/ML Prefilled Syringe [Sajazir] 99% PA
- selexipag 1 MG Oral Tablet [Uptravi] 99% PA
- selexipag 1.6 MG Oral Tablet [Uptravi] 99% PA