Medicare AdvantagePrior AuthHigh impact
Non-preferred Ustekinumab Products (Revised)
Humana·Gastroenterology, Dermatology, Rheumatology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for non-preferred ustekinumab biosimilar products (like Wezlana, Selarsdi, Pyzchiva) effective January 1, 2026. Patients must try preferred products (Stelara, Otulfi, Yesintek) and other specified therapies first before these biosimilars will be covered.
Action Required
By January 1, 2026: Billing team must implement prior authorization workflows for all non-preferred ustekinumab biosimilars including Wezlana, Selarsdi, Pyzchiva, Steqeyma, Imuldosa, and Starjemza. Update prior auth request forms to document required step therapy with preferred products (Stelara, Otulfi, Yesintek) and other specified first-line therapies. Train staff on age-specific criteria and diagnosis requirements for ulcerative colitis, Crohn's disease, psoriasis, and psoriatic arthritis. Claims for these products will be denied without proper prior authorization.