Ustekinumab and Associated Biosimilars

Covers ustekinumab (Stelara®) and associated biosimilars for indications including moderately to severely active Crohn’s disease and ulcerative colitis in adults, with dosing regimens (single IV induction ~6 mg/kg followed by subcutaneous maintenance ~8 weeks later) consistent with authoritative sources and clinical trial protocols. Coverage requires FDA approval or compendia recognition (or two peer‑reviewed articles for off‑label uses), is limited to a single facility‑administered IV induction dose, is subject to member benefit plan terms and exclusions, and includes precautions such as avoiding live vaccines and noncoverage of IV use for non–FDA‑approved indications.

"Requested therapy must be proven effective for the relevant diagnosis or procedure."

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