Stelara (ustekinumab intravenous infusion – Janssen Biotech) — Cigna

Crohn’s Disease

Initial criteria

Patient is age ≥ 18 years; AND
Medication will be used as induction therapy; AND
Patient meets ONE of the following (i, ii, iii, or iv):
i. Patient has tried or is currently taking a systemic corticosteroid, or a systemic corticosteroid is contraindicated; OR
ii. Patient has tried one other conventional systemic therapy for Crohn’s disease (examples include azathioprine, 6-mercaptopurine, or methotrexate). Exception if patient has already tried at least one biologic other than requested medication. A biosimilar of requested biologic does not count. A trial of mesalamine does not count; OR
iii. Patient has enterocutaneous (perianal or abdominal) or rectovaginal fistulas; OR
iv. Patient had ileocolonic resection (to reduce the chance of Crohn’s disease recurrence); AND
Medication is prescribed by or in consultation with a gastroenterologist.

30 days