UHC Formulary Change Impacts Coverage for Ustekinumab

UnitedHealthcare (UHC) recently announced changes to its commercial pharmacy plan that will impact coverage for patients on ustekinumab (Stelara). Effective Sept. 1, the brand name drug Stelara will no longer be covered on the UHC commercial plan prescription drug list. Patients will be required to use either of the preferred alternatives, biosimilar drugs Steqeyma or Yesintek.

All patients will be required to switch to one of the preferred biosimilars, regardless of prior authorization status; however, all current prior authorizations will automatically carry over to the biosimilar.

For more information about this policy change or to request assistance with other practice or insurance issues, please contact [email protected].

After examining study data from pediatric patients with both psoriasis and psoriatic arthritis (PsA), the FDA approved ustekinumab as a treatment for patients aged 6–17 years old with PsA.

Ustekinumab-stba (Steqeyma) now has FDA approval for all forms and dosages of its reference product, ustekinumab (Stelara), including a subcutaneous injection to treat pediatric patients with plaque psoriasis or psoriatic arthritis.

In late October, the FDA approved the first biosimilar to ustekinumab to treat patients with psoriasis, psoriatic arthritis and other conditions. Ustekinumab-auub is expected to be available in the U.S. by 2025.

The use of biosimilars for rheumatology in the U.S. became a reality when the U.S. Food and Drug Administration (FDA) approved Inflectra (infliximab-dyyb), a biosimilar to Remicade (infliximab), in April. What this may mean is increased competition among drug companies with regard to pricing and, therefore, potentially lower costs for U.S. patients, according to Seoyoung…

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