1)
FDA New Drug approvals
at:
http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.DrugDetails
2)
Shear NH, Prinz J, Papp
K, Langley RG, Gulliver WP, Targeting the interleukin-12/23 cytokine family in
the treatment of psoriatic disease.; J Cutan Med Surg.
2008 Dec;12 Suppl 1:S1-10.
3)
Clinical Pharmacology.
Accessed online 6/22/2018.
Addendum:
1.
Effective 01/01/2017:
Removed step therapy requirement of both Humira and Enbrel.
2.
Effective 05/01/2017:
Added indication of Crohn’s disease as covered indication subject to PA
criteria noted
3.
Effective
04/01/2017: Added the following
codes: C9487 – Ustekinumab IV Injection, 1 mg. This was a new code effective
04/01/17 & deleted on 06/30/17. It was replaced with Q9989 – Ustekinumab IV
Injection, 1 mg. This is a new code effective 07/01/17. Updated pre-requisite
therapy for treatment of psoriasis.
4.
Effective 06/01/2018:
Updated phototherapy requirement.
5.
Effective 07/01/2018:
update to include dosing specifications for treating Crohn’s disease.
6.
Effective 10/01/2019:
Update to include J3358.
7.
Effective 01/01/2020:
Updated criteria for PsA and added coverage criteria for Ulcerative Colitis.
8.
Effective 03/01/2020:
Clarified coverage/billing details regarding IV and SC dosage forms.
9.
Effective 10/01/2021:
Updated age for coverage for plaque psoriasis to 6 and older.
10.
Effective 01/01/2022:
Updated to note the subcutaneous dosage form covered under the pharmacy benefit
uses MagellanRx coverage criteria. Criteria for IV dosage form for ulcerative
colitis or Crohn’s Disease remains in this policy.
Resource
Document:
BI258 Stelara RD