Ustekinumab (Stelara)

Stelara (ustekinumab) is covered only for the FDA‑approved indications—moderate‑to‑severe plaque psoriasis (≥12 years), adult active psoriatic arthritis, and adult moderately‑to‑severe Crohn’s disease or ulcerative colitis—and is not covered for non‑FDA uses. Coverage requires meeting indication‑specific prior therapy or corticosteroid trial/contraindication, specialist prescribing/consultation, age and weight documentation, adherence to specified weight‑based induction and maintenance dosing, documented clinical response for reauthorization, with initial approval for 3 months and renewals for 12 months.

"Stelara is indicated for the treatment of patients 12 years or older with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy."

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