Guselkumab (Tremfya) (CPB 1011, reviewed 2026-06-29)
Summary
Aetna considers guselkumab (Tremfya) medically necessary for commercial members with moderate to severe plaque psoriasis, active psoriatic arthritis, moderately to severely active ulcerative colitis, and moderately to severely active Crohn's disease when the listed criteria are met, and considers all other indications experimental, investigational, or unproven. Plaque psoriasis approval requires members to be 6 years of age or older and weigh at least 40 kg, along with body surface area or prior-treatment criteria. Precertification is required for intravenous guselkumab (Tremfya IV) for all Aetna participating providers and members in applicable plan designs.
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