CurrentUnitedHealthcarePolicy 2025 P 3094-13

Step Therapy for Siliq (brodalumab) — Pharmacy Step Therapy Program

Defines UnitedHealthcare's step therapy requirement that members must try specified preferred self-administered injectable alternatives before coverage of Siliq (brodalumab) for plaque psoriasis; applies to Pharmacy benefits where step therapy programs are used.

Policy Summary

PayerUnitedHealthcare

PolicyStep Therapy for Siliq (brodalumab)

Policy CodePolicy 2025 P 3094-13

Change TypeStep therapy requirement revisedcoverage exclusion retained

Effective DateJun 1, 2025

Next Review Date

Key ActionDocument failure, contraindication, or intolerance to three preferred self-administered injectable products (drug name, date, duration) when requesting prior authorization for Siliq; approvals issued for 12 months.

SourceLink

POLICY UPDATE CHANGES

Step therapy requirement changed to require trial of three preferred self-administered injectable products prior to Siliq.

Siliq is excluded from coverage for the majority of benefits.

3preferred agents required

12authorization duration (months)

2025-06-01effective

Siliq excludedcoverage exclusion

Policy Summary

PayerUnitedHealthcare

PolicyStep Therapy for Siliq (brodalumab)

Policy CodePolicy 2025 P 3094-13

Change TypeStep therapy requirement revisedcoverage exclusion retained

Effective DateJun 1, 2025

Next Review Date

SourceLink

On This Page

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.

Coverage Criteria

Initial Therapy

Covered when ALL of the following are met:

Plaque Psoriasis - Step Requirement: Member has history of failure, contraindication, or intolerance to three of the following preferred products: one of the preferred adalimumab products; Cimzia (certolizumab); Cosentyx (secukinumab); Enbrel (etanercept); Skyrizi (risankizumab); Sotyktu (deucravacitinib); one of the preferred ustekinumab products; Tremfya (guselkumab). Document drug, date, and duration of trial.three agents

Infused medications are not part of the criteria; tried/failed alternatives are supported by FDA labeling; authorization will be issued for 12 months.

Exclusion: Siliq (brodalumab) is excluded from coverage for the majority of UnitedHealthcare benefits. This exclusion is retained in the policy and applies regardless of the step therapy program described below; where exclusions do not apply based on a member's specific benefit plan or state mandate, the step therapy criteria govern authorization decisions. Infused medications are not part of the step therapy criteria for the referenced conditions and therefore are not counted toward the required trials of preferred self‑administered injectable products.

Initial Therapy

Initial Therapy — Initial coverage for Siliq

Initial coverage for Siliq:

Initial Siliq approval: Failure, contraindication, or intolerance to three preferred self-administered injectable products as listed (document drug, date, and duration of trial).three agents

Infused medications are excluded from the step therapy requirement; authorization will be issued for 12 months.

Provider Actions & Requirements

Prior Authorization

Step therapy prior authorization

Prior authorization is required. Documentation must show failure, contraindication, or intolerance to three preferred self-administered injectable products before coverage of Siliq (brodalumab) will be considered. Authorization, when approved, will be issued for 12 months. State mandates, federal requirements, and the member's benefit plan may affect coverage.

Step therapy requires documented trial (drug name, dates, duration) of three preferred self-administered injectable products from the following list: one preferred adalimumab product; Cimzia (certolizumab); Cosentyx (secukinumab); Enbrel (etanercept); Skyrizi (risankizumab); Sotyktu (deucravacitinib); one preferred ustekinumab product; Tremfya (guselkumab).
Preferred product lists: see drug coverage tools for specific products and NDCs.
Authorization length: 12 months.
Coverage may be impacted by state mandates, federal regulatory requirements, and the member-specific benefit plan.

Step Therapy Requirements

Step	Required trial	Coverage
1
History of failure, contraindication, or intolerance to three preferred self-administered injectable products (document drug name, date, and duration of trial). Preferred products include: one of the preferred adalimumab products; Cimzia (certolizumab); Cosentyx (secukinumab); Enbrel (etanercept); Skyrizi (risankizumab); Sotyktu (deucravacitinib); one of the preferred ustekinumab products; Tremfya (guselkumab).
Covered with criteria — approval requires documented trials of three preferred self-administered injectable products; infused medications are excluded from the step therapy requirement.

Site of Care

Note

Site‑of‑care rule: infused medications excluded from step therapy

The step therapy criteria and documentation requirements apply only to self‑administered injectable products; infused medications are excluded from the step therapy requirements.

Definitions

Step therapy — definition

DefinitionA step therapy program that requires a member to trial three preferred self‑administered injectable products before coverage of Siliq (brodalumab) is approved.

ScopeApplies to self‑administered injectable alternatives; infused medications for the referenced conditions are excluded from the step therapy requirement.

Required documentationProviders must document the drug name, date, and duration of each preferred agent trial (failure, contraindication, or intolerance).

PurposeEncourage use of preferred, lower‑cost alternatives prior to authorizing Siliq for plaque psoriasis.

Applicable indicationModerate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy and have failed other systemic therapies.

Background

Siliq (brodalumab) is an interleukin‑17 receptor A antagonist indicated for adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. UnitedHealthcare notes that Siliq is excluded from coverage for the majority of benefits, and when coverage is considered under applicable benefits the policy requires step therapy with preferred self‑administered injectable alternatives before Siliq may be approved. Authorization decisions may also consider previous claim/medication history, diagnosis codes, and claim logic per program rules.