AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) implemented updates to the Commercial medical and prescription drug programs on July 1, 2025.
Key Formulary change
- Wezlana™ (ustekinumab-auub) is now the preferred biosimilar for Stelara® SQ or IV under the Commercial Premium Formulary.
- Yesintek™ (ustekinumab-kfce) continues to be the preferred biosimilar for the Select and Value formulary.
Transition details for Stelara
- Pharmacy benefit
- On July 1, 2025, authorizations for Stelara were automatically transitioned to Wezlana or Yesintek (based on the applicable formulary). No new prior authorization is required if an existing authorization for Stelara is in place.
Policy updates
The AmeriHealth Commercial medical policy and pharmacy policy for Stelara have been updated to reflect the new coverage criteria for preferred products.
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