Ustekinumab (Stelara) product management and benefit change
Designates Yesintek (ustekinumab-kfce) as the preferred ustekinumab product for most commercial members and changes pharmacy vs medical benefit handling for SC formulations; excludes Preferred Drug List plans and Medicare Advantage.
Yesintek (ustekinumab-kfce) is designated the preferred ustekinumab product for most commercial members under the pharmacy benefit effective April 1, 2025, and under the medical benefit effective May 1, 2025.
Subcutaneous formulations of ustekinumab will no longer be payable under the medical benefit for dates of service on or after May 1, 2025.
Yesintek SC will be payable only when filled through Walgreens Specialty Pharmacy (with an exception for Michigan Medicine Specialty Pharmacy continuity).
Proactive authorizations for Yesintek SC under the pharmacy benefit will be issued from May 1, 2025 to April 30, 2026 for members transitioning from medical benefit therapy.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.