Stelara® (ustekinumab)

Authorization forms

(forms cover both IV and subcutaneous formulations)

Traditional & Optimized (11/2018)

Medicare Part D (01/2019)

Stelara is not covered for Medicaid

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page

Code(s): J3357 (sc), Q9989 (iv)

Benefit: Medical

Notes: Treatment of moderate to severe plaque psoriasis