Selarsdi

Generic: ustekinumab-aekn

45 MG, 90 MG, 130 MG — Prefilled Syringe

Also known as: ustekinumab-aekn SELARSDI SOLN 130MG/26ML Selarsdi 45 Mg/0.5 Ml Syringe Selarsdi 90 Mg/Ml Syringe Selarsdi Subcutaneous Solution Prefilled Syringe

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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 16 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Complete Gold via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL

AmeriHealth Caritas NC

19 plans

Source: CMS QHP JSON · Checked: 16 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
AmeriHealth Caritas Next Silver Essential + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Essential + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Essential + No Referrals via Stelara	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Signature + No Referrals via Stelara	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Signature + No Referrals via Stelara	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Signature + No Referrals via Stelara	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals via Stelara	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Bronze Premier + No Referrals via Stelara	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Premier + No Referrals via Stelara	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Premier + No Referrals via Stelara	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Essential + No Referrals via Stelara	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Gold Premier + No Referrals	Tier 5 - Specialty	✓	—	—	PA
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals	Tier 5 - Specialty	✓	—	—	PA

Blue Cross Blue Shield of NC

10 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 16 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026 via Stelara	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Advantage 2026 via Stelara	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Local 2026 via Stelara	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Care 2026 via Stelara	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Value 2026 via Stelara	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Advantage 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Local 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Care 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL
BCBSNC Blue Value 2026	Tier 5 - Specialty	✓	—	✓ Restricted Access	PA \| QL

Cigna

40 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 16 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Connect myDiabetesCare Bronze via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 5500 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 6000 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 5000 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3000 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 6500 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold RD CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze CMS Standard	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver CMS Standard via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 3500 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 4400 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 7000 HSA Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze CMS Standard via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD CMS Standard via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold CMS Standard via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 5000 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3500 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD CMS Standard via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold RD CMS Standard via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect myDiabetesCare Silver	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 2200 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold 1500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect myDiabetesCare Bronze	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 5500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 6000 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze RD 5000 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 3500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 7000 HSA Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 4400 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 5000 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver 3000 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Bronze 6500 Indiv Med Deductible	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect myDiabetesCare Silver via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Silver RD 2200 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Connect Gold 1500 Indiv Med Deductible via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL

Medicare Part D

125 plans

Source: CMS QHP JSON · Formulary date: Jun 10, 2026 · Checked: 16 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Longevity Health Plan (HMO I-SNP) via ustekinumab-aekn	Tier 1 - Preferred Generic	✓	—	✓ 1 per 28 days	PA \| QL
Longevity Health Plan (HMO I-SNP)	Tier 1 - Preferred Generic	✓	—	✓ 0.5 per 28 days	PA \| QL
Longevity Health Plan (HMO I-SNP) via Stelara	Tier 1 - Preferred Generic	✓	—	✓ 0.5 per 28 days	PA \| QL
Provider Partners North Carolina Essential Plan (HMO I-SNP) via Stelara	Tier 1 - Preferred Generic	✓	—	✓ 3 per 84 days	PA \| QL
Provider Partners North Carolina Community Plan (HMO I-SNP) via Stelara	Tier 1 - Preferred Generic	✓	—	✓ 3 per 84 days	PA \| QL
Provider Partners North Carolina Advantage Plan (HMO I-SNP) via Stelara	Tier 1 - Preferred Generic	✓	—	✓ 3 per 84 days	PA \| QL
HealthSpring Preferred Select (HMO)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
HealthSpring Preferred Savings (HMO)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
HealthSpring Preferred Plus (HMO)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
HealthSpring True Choice (PPO)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
Troy Medicare (HMO) via ustekinumab-aekn	Tier 3 - Preferred Brand	✓	—	✓ 1 per 28 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Stelara	Tier 3 - Preferred Brand	✓	—	✓ 1 per 28 days	PA \| QL
Troy Medicare (HMO) via Stelara	Tier 3 - Preferred Brand	✓	—	✓ 1 per 28 days	PA \| QL
Troy Medicare (HMO)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP) via Stelara	Tier 3 - Preferred Brand	✓	—	✓ 1 per 28 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP) via ustekinumab-aekn	Tier 3 - Preferred Brand	✓	—	✓ 1 per 28 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via ustekinumab-aekn	Tier 3 - Preferred Brand	✓	—	✓ 1 per 28 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
HealthSpring TotalCare Plus (HMO D-SNP)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
HealthSpring TotalCare (HMO D-SNP)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
HealthSpring Preferred (HMO)	Tier 3 - Preferred Brand	✓	—	✓ 0.5 per 28 days	PA \| QL
Wellcare Giveback Open (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 0.5 per 28 days	PA \| QL
Aetna Medicare Signature (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Dual (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Value Plus (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Prime (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature Care (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Full Dual Care (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Enhanced (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Enhanced (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Enhanced (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature Extra (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature Giveback (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Signature (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Chronic Care (HMO C-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Aetna Medicare Chronic Care Value (HMO C-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
HealthSpring True Choice (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
HealthSpring TotalCare (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
HealthSpring TotalCare Plus (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
HealthSpring Preferred (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
HealthSpring Preferred Select (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
HealthSpring Preferred Savings (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
HealthSpring Preferred Plus (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED DUAL 009 NC (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CORE 001 NC (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED GIVEBACK 002 NC (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED GIVEBACK 012 NC (HMO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE 001 NC (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE 003 NC (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE 005 NC (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE 008 NC (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Simple Open (PPO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Simple (HMO-POS) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Simple Open (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 0.5 per 28 days	PA \| QL
Wellcare Simple (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 0.5 per 28 days	PA \| QL
Wellcare Giveback Open (PPO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Blue Medicare PPO Enhanced (PPO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Blue Medicare Essential Plus (HMO-POS) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Blue Medicare Enhanced (HMO-POS) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Blue Medicare Choice (HMO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Blue Medicare Essential (HMO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Experience Health Medicare Advantage (HMO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Healthy Blue + Medicare (HMO-POS D-SNP) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health Platinum (HMO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health NC Duals (HMO-POS D-SNP) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health smartHMO (HMO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health Platinum Select (HMO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Alignment Health AVA (PPO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HealthTeam Advantage Plan I (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HealthTeam Advantage Plan II (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HealthTeam Advantage Vitality Plan (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Wellcare Dual Liberty Open (PPO D-SNP) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Assist Open (PPO) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Dual Access (HMO-POS D-SNP) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Dual Liberty (HMO-POS D-SNP) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Dual Liberty Open (PPO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 0.5 per 28 days	PA \| QL
Wellcare Assist Open (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 0.5 per 28 days	PA \| QL
Wellcare Dual Access (HMO-POS D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 0.5 per 28 days	PA \| QL
Wellcare Dual Liberty (HMO-POS D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 0.5 per 28 days	PA \| QL
Wellcare Dual Reserve (HMO-POS D-SNP) via ustekinumab-aekn	Tier 5 - Specialty	✓	—	✓ 1 per 28 days	PA \| QL
Wellcare Dual Reserve (HMO-POS D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 0.5 per 28 days	PA \| QL
HumanaChoice H5525-049 (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HumanaChoice H5525-050 (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HumanaChoice H5525-070 (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Dual Select H5525-072 (PPO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HumanaChoice H5525-083 (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus H6622-025 (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus H6622-026 (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus H6622-057 (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus H6622-060 (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus H6622-061 (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Choice H8145-004 (PFFS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus H1036-137 (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus H1036-233 (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Dual Select H1036-307 (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus H1036-335 (HMO-POS) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HumanaChoice Giveback H5216-017 (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HumanaChoice H5216-211 (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Full Access H5525-034 (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HumanaChoice Giveback H5525-035 (PPO) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) via Stelara	Tier 5 - Specialty	✓	—	✓ 3 per 84 days	PA \| QL

NC Medicaid PDL

2 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 16 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via Stelara	Non-Preferred	✓	✓	—	PA \| ST
NC Medicaid Preferred Drug List 2026 via ustekinumab-aekn	Non-Preferred	✓	✓	—	PA \| ST

NC State Health Plan

6 plans

Source: PDF · Formulary date: Jul 1, 2026 · Checked: 16 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026 via Stelara	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026	Not Covered	—	—	—	None
NC State Health Plan - HDHP 2026 via Stelara	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Stelara	Not Covered	—	—	—	None

Oscar Health

28 plans

Source: CMS QHP JSON · Checked: 16 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Gold Elite Saver Plus \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple PCP Saver \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Diabetes \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic 4700 \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Secure \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Diabetes via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Elite Saver Plus via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple PCP Saver via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
AIAN Cost Share \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Secure via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Elite + PCP Saver Plus via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Classic Standard \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic Standard \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic Standard \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Gold Classic Standard via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Classic Standard via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic Standard via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Classic 4700 via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
AIAN Cost Share via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Women's Health with Menopause Benefits \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Chronic Care CKM \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Silver Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Diabetes \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Chronic Care CKM \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits \| with Atrium Health via Stelara	Tier 5 - Specialty	✓	—	✓	PA \| QL

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jun 24, 2026 · Checked: 16 hours, 51 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026 via ustekinumab-aekn	Tier 3 - Non-Formulary	✓	—	—	PA