Stelara® (ustekinumab)

Stelara (ustekinumab) is covered only for FDA‑approved indications — plaque psoriasis and psoriatic arthritis (patients ≥6 years) and Crohn’s disease and ulcerative colitis (adults ≥18) — with non‑FDA uses excluded. Coverage requires indication‑specific criteria including specialist prescribing/consultation, required prior therapy trials (e.g., 3‑month systemic trial or methotrexate contraindication for psoriasis; prior biologic/systemic agent, surgery or steroid history for IBD), IV induction within 2 months before SC maintenance for IBD, weight‑based dosing, detailed documentation (diagnosis, prior therapies, weights, dosing dates), and reauthorization after the specified trial period (psoriasis ≥3 months; PsA/Crohn’s/UC ≥6 months) showing objective or symptomatic benefit; approvals are for 12 months.

"Stelara is indicated for the treatment of patients 6 years or older with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy"