Inflammatory Conditions - Ustekinumab Subcutaneous Products Preferred Specialty Management Policy for Standard/Performance, Value/Advantage, and Total Savings Prescription Drug Lists - (PSM021)
Defines preferred, non-preferred, and non-covered ustekinumab subcutaneous products across pharmacy and medical benefits, required prior authorization and exception criteria directing trials of preferred products, documentation requirements, and product-specific NDC prefixes and routing between pharmacy vs medical benefits.
New policy created.
Tremfya subcutaneous added to Appendix A as a Preferred Non-Ustekinumab Product for Crohn's disease.
Ustekinumab and Ustekinumab-aekn were added as Non-Preferred subcutaneous products; requests directed to Stelara and Selarsdi respectively (later harmonized into same exception criteria).
Imuldosa moved from Step 3 Non-Preferred to Step 1 Preferred (NDCs starting with 69448).
Certain products designated as Non-Covered for Employer Plans (Imuldosa NDCs 51407, Pyzchiva NDCs 83457, ustekinumab-aauz SC, Wezlana SC).
Ustekinumab SC 45mg vial is covered as preferred on the medical benefit only; pharmacy benefit coverage follows table.
Appendix A updated with Non-Ustekinumab Preferred Products including addition of Sotyktu for psoriatic arthritis.
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