Wezlana SC — Medical Mutual

Preferred products

• Stelara SC
• Selarsdi SC
• ustekinumab-ttwe SC
• Yesintek SC

Initial criteria

• Patient has tried ≥1 oral therapy for psoriasis (e.g., methotrexate, cyclosporine, acitretin, PUVA) for ≥3 months OR
• Patient has tried ONE biologic DMARD for ≥3 months OR
• Patient has a contraindication to ≥1 oral agent for psoriasis; AND
• Patient age ≥ 6 years; AND
• Medication prescribed by or in consultation with a dermatologist

Reauthorization criteria

• Patient has received ustekinumab SC for ≥3 months; AND
• Patient experienced improvement from baseline in ≥1 of: body surface area, erythema, induration/thickness, or scale; AND
• Patient experienced symptom improvement (e.g., decreased pain, itching, burning)

Approval duration

initial 3 months, reauth 1 year