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Rx Utilization Management Change for Stelara Effective November 1, 2013

We want to inform you about the following new pharmacy utilization management requirement that will be effective November 1, 2013. 

Stelara (ustekinumab)

Stelara, which is a specialty medication used to treat patients with moderate to severe plaque psoriasis, currently requires prior authorization and is subject to quantity limitations.  As of November 1, 2013, NEW users who self-inject this medication will be required to first try Enbrel or Humira.  Current Stelara users will be grandfathered in and not be subject to this new requirement.  The current prior authorization requirement and quantity limitations will still apply. This new requirement will not apply when Stelara is administered in a provider’s office. 

The detailed approval criteria for this medication (and for Enbrel or Humira) can be found online at

This new requirement will apply to all commercial members who have their pharmacy benefits with us, with the exception of the State Health Plan or any ASO employer groups that carve out their pharmacy benefits to another pharmacy benefits manager.  It does not apply to Federal Employee Program members or Medicare Part D members. 

If you have any questions, please contact the Provider Blue LineSM at 1.800.214.4844.