Stelara (ustekinumab) — United Healthcare

Initial criteria

• Diagnosis of moderately to severely active ulcerative colitis AND Patient is not receiving the requested ustekinumab product in combination with another targeted immunomodulator [e.g., Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), adalimumab, Skyrizi (risankizumab), Tremfya (guselkumab), Cosentyx (secukinumab), Taltz (ixekizumab), Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib), Otezla (apremilast)] for 90 mg/1 mL dose

Reauthorization criteria

• Documentation of positive clinical response to the requested ustekinumab therapy AND Patient is not receiving the requested ustekinumab product in combination with another targeted immunomodulator [same list]

Approval duration

12 months