Ustekinumab – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers ustekinumab for moderate‑to‑severe Crohn’s disease, ulcerative colitis, plaque psoriasis (including adolescents ≥6) and psoriatic arthritis, but deems it unproven/not medically necessary for ankylosing spondylitis and multiple sclerosis. Coverage requires preferred products first (Steqeyma, Wezlana, Yesintek) unless a 14‑week trial with minimal response or documented intolerance/contraindication plus provider attestation justifies a non‑preferred agent, adherence to FDA‑labeled induction/maintenance dosing (IV induction for IBD with SC maintenance ~8 weeks later), specialist prescribing/consultation, documentation of clinical response for continuation, no concomitant targeted immunomodulators, and specified authorization durations.

"Moderately to severely active Crohn's disease (treatment proven) when all specified criteria in the Diagnosis-Specific Criteria are met."