Wezlana (ustekinumab-auub) — United Healthcare

Psoriatic Arthritis

Initial criteria

Diagnosis of active psoriatic arthritis
One of the following: (a) History of failure to a 3‑month trial of methotrexate at maximally indicated dose unless contraindicated or clinically significant adverse effects OR (b) Previously treated with a targeted immunomodulator FDA‑approved for psoriatic arthritis (e.g., Cimzia (certolizumab), adalimumab, Simponi (golimumab), Tremfya (guselkumab), Xeljanz (tofacitinib), Otezla (apremilast), Rinvoq (upadacitinib)) OR (c) Both of the following: i. Currently on requested ustekinumab product as documented by claims or records AND ii. Has not received manufacturer free sample or assistance to establish as current user
Not receiving ustekinumab 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)]
Prescribed by or in consultation with a rheumatologist or dermatologist

Documentation of positive clinical response to ustekinumab therapy
Not receiving ustekinumab in combination with another targeted immunomodulator [same list as above]

12 months