Stelara (ustekinumab)
Billing
Code: J3358
Description: Ustekinumab, iv inject, 1 mg
Unit: 1 mg
Payment: $12.619
Pay quarter: Q4 2023
Dosage and Frequency
Psoriasis (Ps)
For adult patients (age 18 or older)
• 45mg SQ if patient weighs less than or equal to 100kg
• 90mg SQ if patient weighs greater than 100kg
For pediatric patients (age 6-17)
• 0.75mg/kg if patient weighs less than 60kg
• 45mg if patient weighs 60-100kg
• 90mg if patient weighs greater than 100kg
Induction:
• at weeks 0 and 4
Maintenance:
• every 12 weeks
For adult patients (age 18 or older)
• 45mg SQ if patient weighs less than or equal to 100kg
• 90mg SQ if patient weighs greater than 100kg
For pediatric patients (age 6-17)
• 0.75mg/kg if patient weighs less than 60kg
• 45mg if patient weighs 60-100kg
• 90mg if patient weighs greater than 100kg
Induction:
• at weeks 0 and 4
Maintenance:
• every 12 weeks
Psoriatic Arthritis (PsA)
• 45mg SQ
• 90mg SQ if patient weighs greater than 100kg with co-existent moderate-to-severe plaque psoriasis
Induction:
• at weeks 0 and 4
Maintenance:
• every 12 weeks
• 45mg SQ
• 90mg SQ if patient weighs greater than 100kg with co-existent moderate-to-severe plaque psoriasis
Induction:
• at weeks 0 and 4
Maintenance:
• every 12 weeks
Crohn's Disease (CD)
Ulcerative Colitis
Induction:
• 250mg IV if patient weighs less than or equal to 55kg
• 390mg IV if patient weighs 55-85kg
• 520mg IV if patient weighs greater than 85kg
Maintenance:
• 90mg SQ every 8 weeks
Ulcerative Colitis
Induction:
• 250mg IV if patient weighs less than or equal to 55kg
• 390mg IV if patient weighs 55-85kg
• 520mg IV if patient weighs greater than 85kg
Maintenance:
• 90mg SQ every 8 weeks
Calculate drug reimbursement
Total Reimbursement:
$4,921.41(ASP: $4,642.84, Margin: $278.57)
Code:
J3358# Units to bill:
390Prior Authorization
Prior auth criteria for Stelara may include but is not limited to:
1. The patient has had an inadequate response to, or is intolerant to, other systemic treatments including ciclosporin, methotrexate, and/or other biologic agents.
2. The patient has been diagnosed with moderate to severe plaque psoriasis with a Psoriasis Area and Severity Index (PASI) score of 10 or greater.
3. The patient has had an inadequate response to topicals, UV, and/or phototherapy.
4. The patient does not have an active infection.
5. The patient is 18 years of age or older.
Insurance prior auth guidelines:
Billable NDCs
57894-0054-27
STELARA (IV Infusion) (JANSSEN BIOTECH, INC.)
130 MG
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