Ustekinumab (Stelara)

Stelara (ustekinumab) is covered only for its FDA‑approved indications — moderate‑to‑severe plaque psoriasis (age ≥12), adult active psoriatic arthritis, and adult moderately‑to‑severely active Crohn’s disease — with no compendial off‑label uses and not allowed in combination with another biologic. Coverage requires documentation of age/weight and the specific indication plus required prior therapy trials/failures per indication (e.g., phototherapy/systemic agents for psoriasis; TNF inhibitor for psoriatic arthritis; TNF inhibitor, immunomodulator, or steroid failure for Crohn’s), absence of clinically active infection with TB screening/treatment if latent, weight‑based dosing per indication, and approvals are limited to 12 months (reauthorization requires clinical improvement or stability).

"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."