Otulfi

Generic: ustekinumab-aauz

45 MG, 90 MG, 130 MG — Prefilled Syringe

Interleukin-12 Antagonist

Also known as: ustekinumab-aauz OTULFI SOLN 130MG/26ML

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: CMS QHP JSON  ·  Formulary date: Sep 22, 2026  ·  Checked: 15 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Gold Copay Focus + $0 Deductible + Free PCP + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ustekinumab-aauz
Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ustekinumab-aauz
Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ustekinumab-aauz
Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ustekinumab-aauz
Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ustekinumab-aauz
Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ustekinumab-aauz
Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Premier + No Referrals
via ustekinumab-aauz
Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ustekinumab-aauz
Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via ustekinumab-aauz
Tier 5 - Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 15 hours, 25 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Focus 2026
via ustekinumab-aauz
Tier 2 - Preferred Brand ✓ — — PA
BCBS Federal Basic Option 2026
via ustekinumab-aauz
Tier 4 - Preferred Specialty ✓ — — PA
BCBS Federal Standard Option 2026
via ustekinumab-aauz
Tier 4 - Preferred Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Sep 16, 2026  ·  Checked: 15 hours, 24 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Longevity Health Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 0.5 per 28 days PA | QL
Humana Gold Plus H6622-060 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H6622-061 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Choice H8145-004 (PFFS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Troy Medicare (HMO)
via ustekinumab-aauz
Tier 3 - Preferred Brand ✓ — ✓ 0.5 per 28 days PA | QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via ustekinumab-aauz
Tier 3 - Preferred Brand ✓ — ✓ 0.5 per 28 days PA | QL
AmeriHealth Caritas VIP Care (HMO D-SNP)
via ustekinumab-aauz
Tier 3 - Preferred Brand ✓ — ✓ 0.5 per 28 days PA | QL
HumanaChoice H5525-083 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H6622-026 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H6622-057 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice Giveback H5525-035 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice H5525-049 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice H5525-050 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice H5525-070 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Dual Select H5525-072 (PPO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H6622-025 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H1036-233 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Dual Select H1036-307 (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H1036-335 (HMO-POS) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice Giveback H5216-017 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice H5216-211 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Humana Full Access H5525-034 (PPO) Tier 3 - Preferred Brand ✓ — ✓ 1.5 per 84 days PA | QL
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 15 hours, 24 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026
via ustekinumab-aauz
Non-Preferred ✓ ✓ — PA | ST
Source: PDF  ·  Formulary date: Oct 1, 2026  ·  Checked: 15 hours, 24 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - HDHP 2026
via ustekinumab-aauz
Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026
via ustekinumab-aauz
Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via ustekinumab-aauz
Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026 Not Covered — — — None
NC State Health Plan - 80/20 Plus PPO 2026 Not Covered — — — None
NC State Health Plan - HDHP 2026 Not Covered — — — None
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