Policies & Regulations
Important biosimilar updates for Medicare Advantage formularies

​​AmeriHealth Insurance Company of New Jersey (AmeriHealth) has implemented updates to the Medicare Advantage and Medicare Part D prescription drug programs effective September 1, 2025.

  • Yesintek™ (ustekinumab-kfce) is now the preferred biosimilar for Stelara®.
  • Jubbonti® (denosumab-bbdz) is now the preferred biosimilar for Prolia®.

Transition details for Stelara

  • ​​Pharmacy benefit:
    • ​Stelara SQ was removed from the Medicare closed formularies and is now considered non-formulary. For the Medicare open formularies, Stelara SQ is no longer preferred.
    • The preferred ustekinumab product is now Yesintek (ustekinumab-kfce), a lower-cost biosimilar of Stelara. Members will be notified of this change by mail in September.
    • AmeriHealth members can now access Yesintek from their existing pharmacy. No new prior authorization for Yestinek is needed if there is an existing authorization for Stelara. As of September 1, 2025, all existing authorizations for Stelara have been transitioned to Yesintek for the remainder of the existing authorization period.
  • Medical benefit:
    • ​For Medicare Advantage members, Stelara IV is now non-preferred, and they can receive Yesintek IV.
 
Transition details for Prolia

  • Pharmacy benefit:
    • ​Prolia was removed from the Medicare closed formularies and is now considered non-formulary. For the Medicare open formularies, Prolia is no longer preferred.
    • The preferred denosumab product is now Jubbonti (denosumab-bbdz), a lower-cost biosimilar of Prolia. Members will be notified of this change by mail in September.
    • AmeriHealth members can now access Jubbonti from their existing pharmacy. No new prior authorization for Jubbonti is needed if there is an existing authorization for Prolia. As of September 1, 2025, all existing authorizations for Prolia have been transitioned to Jubbonti for the remainder of the existing authorization period.

Policy updates

The AmeriHealth Medicare Advantage medical policy and pharmacy policy for Stelara and Prolia have been updated to reflect the new coverage criteria for preferred products.

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