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)

By November 15, 2026: Billing and prior authorization teams must prepare systems for implementation of this ustekinumab products policy effective December 1, 2026. Update prior authorization workflows to require: (1) specialty-specific prescriber validation (dermatologist for psoriasis, rheumatologist/dermatologist for PsA, gastroenterologist for GI conditions, gastroenterologist/hematologist/oncologist for toxicity); (2) clinical documentation requirements per indication (BSA affected, medication history, clinical response); (3) authorization periods of 12 months for covered indications and 6 months for immune checkpoint inhibitor-related toxicity. Coordinate with providers to ensure understanding of step therapy requirements referenced in the separate Step Therapy Guide document. Create encounter form reminders for providers to include required clinical documentation (BSA reduction, symptom improvement, disease activity measures) at continuation requests. Failure to implement prior authorization controls will result in claim denials for non-compliant requests.