Tremfya® Intravenous (guselkumab)

Covered: Tremfya (guselkumab) IV is covered only as induction therapy (200 mg IV at Weeks 0, 4, and 8; authorization limited to 3 months) for adults ≥18 with ulcerative colitis or for pouchitis after specified local treatments, and is excluded for patients <18, for maintenance use, or without the required prior therapies (mesalamine products or biosimilars do not count as prior systemic therapy). Key requirements: prescription by or consult with a gastroenterologist and documentation of age, diagnosis, and prior therapy—either one systemic UC therapy (e.g., a biologic, azathioprine, 6‑MP, cyclosporine, tacrolimus, or corticosteroid) or, for pouchitis, trial of an antibiotic/probiotic/corticosteroid enema/mesalamine enema—and confirmation of the specified dosing schedule.

"Induction treatment of ulcerative colitis (FDA-Approved Indication)."

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