Stelara IV biosimilars added to Medicaid coverage 6/1, Stelara IV to be removed from coverage 8/1

The following coverage changes are in process for Stelara® IV and Stelara IV biosimilars under the medical benefit for Priority Health Medicaid members:

• Effective June 1, the below Stelara IV biosimilars were added to coverage under the medical benefit for our Medicaid members:
  o Otulfi® IV (ustekinumab-aauz)
  o Pyzchiva® IV (ustekinumab-ttwe)
  o Selarsdi™ IV (ustekinumab-aekn)
  o Steqeyma® IV (ustekinumab-stba)
  o Ustekinumab IV (unbranded Stelara)
  o Yesintek (ustekinumab-kfce)
  
  
• Effective August 1, Stelara IV will be removed from coverage under the medical benefit for our Medicaid members

What do you need to do?

Review coverage (login required) and criteria for the Stelara biosimilars listed above. For Priority Health Medicaid members eligible for ustekinumab therapy, submit a prior authorization using the Medicaid medical drug authorization form posted on the Medicaid Approved Drug List (ADL).

For Stelara biosimilar maintenance doses, authorization requests for the corresponding subcutaneous biosimilar product may be submitted using the Medicaid prior authorization form posted on the ADL, or via electronic prior authorization (ePA).