Includes updated information regarding changes for the biosimilar adoption for Actemra® to Tyenne®.
AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) and AmeriHealth Administrators are committed to finding innovative ways to make specialty drugs more affordable while ensuring members have access to the medications they need.
That’s why AmeriHealth and AmeriHealth Administrators are closely monitoring the launch of biosimilars for two key drugs, Stelara® (ustekinumab) and Actemra (tocilizumab).
Effective July 1, 2025, the following updates will be implemented to both the Commercial medical and prescription drug programs:
YesintekTM (ustekinumab-kfce) will be the preferred biosimilar for Stelara under the Commercial medical and Select Drug Program Formulary® and Value Formulary drug programs.
Tyenne (tocilizumab-aazg) will be the preferred biosimilar for Actemra under the Commercial medical program.
How will this affect your patients (our members)?
Transition from Stelara
Pharmacy benefit:
Stelara SQ will be removed from the Commercial AmeriHealth Value and will be considered non-formulary. For the Select Drug Program Formulary, Stelara SQ will no longer be preferred.
The preferred ustekinumab product will be Yesintek (ustekinumab-kfce), a lower-cost biosimilar of Stelara. Members were notified of this change by mail.
AmeriHealth members will be able to access Yesintek from their existing pharmacy. No new prior authorization for Yestinek is needed if there is an existing authorization for Stelara. Beginning July 1, 2025, all existing authorizations for Stelara will be transitioned to Yesintek for the remainder of the existing authorization period.
Medical benefit:
For Commercial members, Stelara SQ and Stelara IV will be non-preferred. All existing authorizations for Stelara will be transitioned to Yesintek beginning July 1, 2025.
Providers can transition all SQ formulations to the pharmacy benefit. Commercial members with an AmeriHealth pharmacy benefit will switch to Yesintek, while those with a different pharmacy benefit manager (PBM) will transition based on their specific benefits.
Transition from Actemra
Contact us
In May, select providers received letters about these biosimilar changes under the medical benefit, including an email address that failed to work properly. Going forward, if you need to contact us about patients with a contraindication(s) or intolerance(s) to Yesintek or Tyenne, please contact us at the email addresses below.
Why are these changes happening?
AmeriHealth is constantly evaluating best practice standards and industry trends to help manage specialty drug costs. Stelara and Actemra are widely used biologics that drive significant specialty drug costs. The U.S. Food and Drug Administration (FDA) has approved several biosimilars for these drugs, confirming they match the originals in safety and effectiveness.*
Designating preferred products allows AmeriHealth to take advantage of the growing availability of biosimilars, as well as competition between biosimilars and reference products. This competition may help reduce costs and expand members' access to more affordable therapies.
Policy updates
The AmeriHealth Commercial medical policy and pharmacy policy for Stelara and Actemra will be updated to reflect the new coverage criteria for preferred products.
*U.S. Food & Drug Administration. “Biosimilar and Interchangeable Products." 2017. Available from: https://www.fda.gov/drugs/things-know-about/9-things-know-about-biosimilars-and-interchangeable-biosimilars
25-0062