All PlansPrior AuthHigh impact
Ustekinumab Products: Ustekinumab (Stelara®); Ustekinumab-auub (Wezlana™); Ustekinumab-srlf (Imuldosa™); Ustekinumab-aauz (Otulfi™); Ustenkinumab-ttwe (Pyzchiva™), Ustekinumab-aekn (Selarsdi™); Ustenkinumab-stba (Steqeyma™); Ustenkinumba-kfce (Yesintek™); ustekinumab; ustekinumab-aauz, ustekinumab-stba, ustekinumab-aekn ; ustekinumab-auub; ustenkinumabttwe, Ustekinumab-hmny (Starjemza)
BCBS Tennessee·TN · Dermatology, Rheumatology, Gastroenterology +2 more·Medical Policy
Effective date
Jun 30, 2026
We identified it
Jun 17, 2026
Summary
New prior authorization policy for ustekinumab products (Stelara and biosimilars) covering psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis, and immune checkpoint inhibitor-related toxicity. Requires specific documentation and specialist prescribing with step therapy requirements for some agents.
Action Required
Before June 30, 2026: Update prior authorization workflows for all ustekinumab products (Stelara, Wezlana, Imuldosa, Otulfi, Pyzchiva, Selarsdi, Steqeyma, Yesintek, Starjemza). Billing team must ensure dermatologists prescribe for psoriasis/PsA, gastroenterologists for CD/UC, and hematologist/oncologists for checkpoint inhibitor toxicity. Update system to require documentation of BSA affected, previous therapy responses, and clinical improvement measures. Review step therapy guide at provided URL. Claims will require prior auth approval starting effective date.