Coverage changes coming for Stelara, Yesintek and Selarsdi

Effective Jun. 1, 2025, we’re removing Stelara® from coverage under the pharmacy benefit for our commercial group and individual members. Coverage for Stelara under the medical benefit will continue.

Under the Medicare Part B benefit, Stelara intravenous (IV) will become non-preferred with step therapy requirements added for members who haven’t yet been approved for this therapy. Those already approved for Stelara IV under the Medicare Part B benefit won’t be impacted by this change.

To continue providing our members with safe and affordable therapies, the following Stelara biosimilars will be added to coverage for Medicare Part D, Medicare Part B and commercial group and individual members under the medical and pharmacy benefit beginning Apr. 1, 2025:

• Yesintek (ustekinumab-kfce)

• Selarsdi (ustekinumab-aekn)
  
  

What do these drugs treat?

Stelara, Yesintek and Selarsdi are formulations of ustekinumab that treat symptoms of plaque psoriasis, psoriatic arthritis, Crohn's disease and ulcerative colitis. Yesintek and Selarsdi are biosimilars of Stelara and are effective, safe and have undergone the same rigorous testing and FDA approval process.

What do you need to do?

For Priority Health patients who’ve been approved for Stelara induction dosing:
Stelara will remain covered and no action from you is required.

For Priority Health patients who’ve been approved for Stelara maintenance dosing:
We recommend writing a new prescription for a covered Stelara biosimilar for your impacted Priority Health patients. To make this transition easier for you, we’ve transferred the Stelara prior authorization approvals we have on file for these patients to Yesintek and Selarsdi.

• An interchangeable status for Yesintek and Selarsdi is expected to be granted by the Food and Drug Administration (FDA) by May 1, 2025 under the pharmacy benefit. Once this status has been granted, Yesintek and Selarsdi may be substituted for Stelara at the pharmacy, and you’ll no longer be required to write new prescriptions* for these drugs. *Rules for interchangeable status vary by state. If your patient is filling their prescription at a pharmacy outside of Michigan, a new prescription for Yesintek or Selarsdi may be required.

For Priority Health patients seeking treatment for plaque psoriasis, psoriatic arthritis, Crohn's disease or ulcerative colitis:
We recommend treatment with Yesintek or Selarsdi.

How are we communicating this to members?

Impacted members will receive a letter advising them of their drug coverage changes, effective date and what steps they can take prior to Jun. 1, 2025. To avoid therapy interruptions, members are encouraged to speak with their providers about transitioning to Yesintek or Selarsdi.

Why the change?

As the market changes, we’re committed to assessing our formularies to ensure our members have access to the right drugs at the right cost.

Have questions?

Contact the Pharmacy Provider Helpline at 800.466.6642.