Wezlana (ustekinumab-auub) — United Healthcare

Psoriatic Arthritis (PsA)

Initial criteria

Diagnosis of active psoriatic arthritis 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 45 mg/0.5 mL dose
Diagnosis of active psoriatic arthritis AND Patient’s weight is > 100 kg (220 lbs.) AND Patient is not receiving the requested ustekinumab product in combination with another targeted immunomodulator [same list] for 90 mg/1 mL dose

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]

12 months