We want to make you aware of upcoming coverage changes related to Stelara (ustekinumab) and biosimilars. We have notified affected members of these changes, as well.
For senior products and Tufts Health One Care
Effective July 1, 2025, for Tufts Medicare Preferred, Tufts Health Plan Senior Care Options, and Tufts Health One Care, the ustekinumab biosimilars Yesintek (ustekinumab-kfce) and Steqeyma (ustekinumab-stba) are being added to the part D formulary and Stelara is being removed.
To continue providing ustekinumab therapy, prescribers should utilize Yesintek and Steqeyma for these members, which will be more cost effective for your patients than Stelara.
Prior authorization is required for these medications. However, the existing authorization for Stelara will be valid for Yesintek and Steqeyma, and you do not need to submit a new prior authorization request until that prior authorization expires.
We strongly recommend that you write a new prescription for Yesintek or Steqeyma to make the transition as seamless as possible.
For Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, and Tufts Health Direct
Effective Sept. 1, 2025 for our commercial and Tufts Health Direct products, Yestinek will be added to the formulary at a preferred status with prior authorization required, while Stelara and all other FDA-approved biosimilars will be non-preferred, non-formulary.
Patients currently utilizing Stelara will not need a new prior authorization request for Yesintek; however, we strongly recommend that you write a new prescription for Yesintek to make the transition as seamless as possible.