Tremfya® (Guselkumab) – Commercial Medical Benefit Drug Policyopen_in_new

Covers intravenous Tremfya (guselkumab) for moderately to severely active ulcerative colitis and Crohn’s disease when given as the three FDA‑labeled IV induction doses and excludes self‑administered subcutaneous Tremfya (handled under the pharmacy benefit except limited California exceptions). Approval requires documented diagnosis, prior‑therapy failure per indication (UC: inadequate response to oral corticosteroids/immunosuppressants or prior UC‑approved targeted immunomodulator; CD: failure of conventional therapies or prior CD‑approved targeted immunomodulator), no concomitant targeted immunomodulator use, prescriber specialty or gastroenterology consultation, and prior authorization issued for three induction doses.

"Ulcerative Colitis (UC): "Diagnosis of moderately to severely active ulcerative colitis" when all of the following are met: Tremfya is to be administered as three intravenous induction doses; Tremf..."