Stelara’s Shift From Medicare B To D Was Costly, OIG Finds, How Much Will IRA Reforms Help?

 
• By Cathy Kelly
  
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The analysis was released days before the Biden Administration is expected to announce a reduced Medicare Part D price for Johnson & Johnson’s immunosuppressant resulting from the government negotiation program established by the Inflation Reduction Act. 

Stelara's Inclusion On the SAD List Drove a Big Increase In Part D Spending. • Source: Shutterstock

A new report by the Health and Human Services Department’s Office of Inspector General found that Medicare paid 80% more, on average, for Johnson & Johnson’s Stelara for the same conditions in 2021 when it was obtained under Part D instead of Part B.

Key Takeaways

  • Medicare and beneficiary costs for Stelara increased sharply after the drug was excluded from Part B coverage in 2021, but use shifted to Part D, the HHS Office of Inspector General concluded in a recent report.

The OIG also found that from 2016 through 2021, the average Part B cost of Stelara remained relatively steady, fluctuating...

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