A popular biologic medicine used to combat autoimmune diseases cost Medicare and its beneficiaries considerably more when the injectable treatment was obtained at pharmacies rather than injected in physician offices due to different methods for determining payment, a new analysis found.
The drug in question is Stelara, which is made by Johnson & Johnson and approved to combat psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis. But it has grown increasingly expensive for Medicare, as spending rose from $300 million in 2016 to almost $3 billion in 2023, according to the report by the Office of Inspector General of the Department for Health and Human Services.
The reason for the steep increase was attributed to the Medicare Part D program in which beneficiaries obtain their medicines through pharmacies. During that seven-year period, the average cost of a Stelara injection through Part D rose from $17,700 to $32,500, an 84% jump. But the cost through the Part B program, in which doctors inject the medicine in their offices, fell from $14,450 to nearly $13,000.
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