Yesintek (ustekinumab-kfce) — Point32Health

Initial criteria

• Documented diagnosis of ulcerative colitis
• Patient age ≥ 18 years
• Prescribed by or in consultation with a gastroenterologist
• Documentation of one (1) of the following:
• a. Inadequate response or adverse reaction to a corticosteroid, a 5-aminosalycylate, 6-mercaptopurine, or methotrexate
• b. Contraindication to corticosteroids, 5-aminosalycylates, 6-mercaptopurine, and methotrexate
• c. The patient is moderate to high risk as evidenced by deep ulcers on colonoscopy, long segments of small and/or large bowel involvement, perianal disease, extra-intestinal manifestations (e.g., fever, weight loss, abdominal pain, intermittent nausea/vomiting), history of bowel resections, or recent hospitalization for the disease
• d. Previous treatment with a biologic agent indicated for the requested use
• e. The patient is new to the plan and has been stable on the requested agent prior to enrollment