CommercialCoverageMedium impact
08.00.82p, Ustekinumab for Intravenous Infusion
Independence Blue Cross·Gastroenterology, Dermatology, Rheumatology·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Ustekinumab for intravenous infusion policy has been updated with changes to coverage position, medical necessity criteria, and coding guidelines. This affects billing and prior authorization requirements for this specialty medication used to treat autoimmune conditions.
Action Required
By January 1, 2026: Billing team must review updated medical necessity criteria for ustekinumab IV infusions and update prior authorization workflows accordingly. Verify current coding guidelines are being followed and update billing system rules for this specialty pharmacy benefit. Review coverage position changes to ensure compliant claim submission.