Loading...

UnitedHealthcare Taltz Prior Auth Coverage Update | OpenPayer

CurrentUnitedHealthcarePolicy Program Number 1 = 2025 P 1183-11

Taltz (ixekizumab) prior authorization / coverage criteria

Prior authorization program for Taltz (ixekizumab) for indicated conditions (plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis) describing initial and reauthorization medical necessity criteria and program rules. Applies to UnitedHealthcare pharmacy benefits; plan-specific exclusions may apply.

Policy Summary

PayerUnitedHealthcare

PolicyTaltz (ixekizumab) prior authorization / coverage criteria

Policy CodePolicy Program Number 1 = 2025 P 1183-11

Change TypeExamples updated (no change to clinical intent)

Effective DateFeb 15, 2026

Next Review Date

Key ActionSubmit prior authorization for Taltz and provide documentation of positive clinical response at reauthorization; approvals are issued for 12 months when criteria are met.

SourceLink

POLICY UPDATE CHANGES

Updated examples of targeted immunomodulators in the 'not receiving in combination' language with no change to clinical intent.

12authorization duration for approved requests

4indications addressed (plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis)

listedmultiple examples provided to define combination therapy exclusion

Medical Necessity Criteria for Taltz (ixekizumab)

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.

Moderate to severe plaque psoriasis — Initial Authorization

Approved when ALL of the following are met:

ALL of the following

Diagnosis of moderate to severe plaque psoriasis
Patient is not receiving Taltz in combination with another systemic targeted immunomodulator for treatment of the same indication
Examples of systemic targeted immunomodulators provided (e.g., adalimumab, bimekizumab, certolizumab, secukinumab, etanercept, tildrakizumab, apremilast, risankizumab, brodalumab, deucravacitinib, guselkumab, ustekinumab)

Moderate to severe plaque psoriasis — Reauthorization

Approved when ALL of the following are met:

ALL of the following

Documentation of positive clinical response to Taltz therapy
No specific metrics required in policy text; clinical response must be documented
Patient is not receiving Taltz in combination with another systemic targeted immunomodulator for treatment of the same indication
Examples of systemic targeted immunomodulators provided (e.g., adalimumab, bimekizumab, certolizumab, secukinumab, etanercept, tildrakizumab, apremilast, risankizumab, brodalumab, deucravacitinib, guselkumab, ustekinumab)

Active psoriatic arthritis — Initial Authorization

Approved when ALL of the following are met:

ALL of the following

Diagnosis of active psoriatic arthritis
Patient is not receiving Taltz in combination with another systemic targeted immunomodulator for treatment of the same indication
Examples provided (includes abatacept, upadacitinib, golimumab, tofacitinib among others)

Active psoriatic arthritis — Reauthorization

Approved when ALL of the following are met:

ALL of the following

Documentation of positive clinical response to Taltz therapy
Clinical response must be documented; examples of concomitant agents provided in policy
Patient is not receiving Taltz in combination with another systemic targeted immunomodulator for treatment of the same indication
Examples provided (e.g., abatacept, upadacitinib, golimumab, tofacitinib, and others)

Active ankylosing spondylitis or active non-radiographic axial spondyloarthritis — Initial Authorization

Approved when ALL of the following are met:

ALL of the following

Diagnosis of active ankylosing spondylitis or active non-radiographic axial spondyloarthritis
Patient is not receiving Taltz in combination with another systemic targeted immunomodulator for treatment of the same indication
Examples provided (includes baricitinib, abatacept, golimumab, upadacitinib, tofacitinib among others)

Active ankylosing spondylitis or active non-radiographic axial spondyloarthritis — Reauthorization

Approved when ALL of the following are met:

ALL of the following

Documentation of positive clinical response to Taltz therapy
Clinical response must be documented; examples of concomitant agents provided in policy
Patient is not receiving Taltz in combination with another systemic targeted immunomodulator for treatment of the same indication
Examples provided (includes baricitinib, abatacept, golimumab, upadacitinib, tofacitinib among others)

Program-level rules / caveats

Additional rules UnitedHealthcare may apply when evaluating requests:

ANY of the following

Authorization may be approved based solely on previous claim/medication history, diagnosis codes (ICD-10), and/or claim logic
Medical necessity, supply limits and/or step therapy may be in place
Plan-specific exclusions may apply; Taltz is excluded from coverage for the majority of benefits — refer to member-specific plan details