Ilumya® (Tildrakizumab-Asmn) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Ilumya (tildrakizumab) for adults with moderate-to-severe plaque psoriasis (candidates for systemic therapy/phototherapy) as a self‑administered subcutaneous drug under the pharmacy benefit (medical benefit or provider administration only if plan permits or physician attests patient cannot self‑inject), and it is not to be used in combination with other targeted immunomodulators. Coverage requires prior authorization with documentation of ≥3% BSA or special-area/severe scalp disease, either failure/intolerance to specified topical therapy plus a 3‑month methotrexate trial (unless contraindicated) OR prior biologic/tsDMARD therapy plus failure/intolerance to three preferred biologics, dermatologist prescriber/consultation, FDA‑label dosing, physician attestation if provider‑administered, documentation of response for continuation, and authorizations limited to 12 months.

"Ilumya to be used as a self-administered, subcutaneous injection for the treatment of plaque psoriasis should be obtained under the pharmacy benefit, unless otherwise specified in the member's bene..."