Topic

Stelara (ustekinumab)

A collection of 21 issues

Myths vs. Facts: Getting Stelara (ustekinumab) Covered by Blue Cross Blue Shield in Virginia - Appeals Guide 2025

Answer Box: Getting Stelara Covered by BCBS Virginia Eligibility: BCBS Virginia (Anthem) requires prior authorization for Stelara with step therapy criteria—patients typically need documented failure of preferred biologics or contraindications. Fastest path: Submit complete PA request with TB screening, disease severity scores (PASI >10 for psoriasis, CDAI >

Renewing Stelara (Ustekinumab) Coverage with UnitedHealthcare in Michigan: 2025 Timeline, Forms, and Appeal Options

Quick Answer: Renewing Stelara Coverage with UnitedHealthcare in Michigan Important Update: UnitedHealthcare no longer covers brand-name Stelara as of September 2024. You must switch to preferred biosimilars (Steqeyma or Yesintek) or meet strict medical exception criteria. For renewals: submit documentation 30 days before current authorization expires, include clinical response evidence,

How to Get Stelara (Ustekinumab) Covered by Cigna in Pennsylvania: Coding, Appeals, and Step Therapy Guide

Answer Box: Getting Stelara Covered by Cigna in Pennsylvania Fastest path to approval: Complete Cigna's prior authorization form with proper ICD-10 codes (L40.0 for plaque psoriasis, K50.x for Crohn's), document step therapy failures, and include specialist notes showing medical necessity. If denied, Pennsylvania'

How to Get Stelara (Ustekinumab) Covered by Cigna in New Jersey: Coding, Appeals, and Step Therapy Guide

Quick Answer: To get Stelara (ustekinumab) covered by Cigna in New Jersey, you'll need prior authorization with specific ICD-10 codes, documented step therapy failures, and TB screening. If denied, New Jersey's IHCAP external review program (managed by Maximus Federal Services) overturns about 68% of specialty drug

Myths vs. Facts: Getting Stelara (Ustekinumab) Covered by Aetna CVS Health in Michigan

Answer Box: Getting Stelara (ustekinumab) covered by Aetna CVS Health in Michigan requires prior authorization with documented step therapy failure and TB screening. The fastest path: 1) Submit complete PA request with specialist prescription and prior treatment history, 2) If denied, file internal appeal within 180 days, 3) Request Michigan

Renewing Stelara (Ustekinumab) Coverage with Cigna in New York: Timeline, Forms, and Appeal Options

Answer Box: Renewing Stelara Coverage with Cigna in New York Cigna requires prior authorization renewal for Stelara every 6 months (initial) to 1 year (continuation). Start renewal 30-45 days before expiration. Submit updated clinical documentation showing continued response via PASI scores, CDAI, or Mayo scores through your prescriber. If coverage

Myths vs. Facts: Getting Stelara (Ustekinumab) Covered by Aetna CVS Health in Illinois

Answer Box: The Truth About Getting Stelara Covered in Illinois Myth-busting reality: Your doctor's prescription alone doesn't guarantee Aetna CVS Health coverage for Stelara (ustekinumab). Success requires meeting specific prior authorization criteria, including tuberculosis screening, documented treatment failures, and specialist attestation. Illinois patients have strong appeal

How to Get Stelara (Ustekinumab) Covered by Blue Cross Blue Shield of Michigan: Timeline, Forms, and Appeals Guide

Quick Answer: Getting Stelara Covered by BCBS Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Stelara (ustekinumab). Key change: Starting April 1, 2025, BCBS Michigan will only cover Yesintek (ustekinumab biosimilar) for most commercial members, not brand-name Stelara. You'll need step therapy (trying preferred alternatives

Renewing Stelara (Ustekinumab) Approval with Blue Cross Blue Shield of Texas: 2025 Requirements & Timeline

Answer Box: Renewing Stelara with Blue Cross Blue Shield of Texas Blue Cross Blue Shield of Texas requires annual prior authorization renewal for Stelara (ustekinumab) 30-60 days before expiration. You'll need updated clinical documentation showing continued medical necessity and treatment response. Start early: BCBSTX makes decisions within 3

Do You Qualify for Stelara (Ustekinumab) Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Getting Stelara Covered by UnitedHealthcare in Virginia Quick Answer: UnitedHealthcare now prefers biosimilars (Steqeyma, Yesintek) over brand Stelara as of September 2024. To qualify for Stelara coverage, you'll need prior authorization showing medical necessity and documented failure/intolerance to preferred alternatives. First step: Have your doctor