Stelara Subcutaneous

45 MG/0.5ML — Prefilled Syringe

Interleukin-12 Antagonist

Also known as: Stelara Subcutaneous Solution Prefilled Syringe Stelara Subcutaneous Solution
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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.
Source: CMS QHP JSON  ·  Checked: 10 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas Next Silver Premier + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Essential + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Gold Signature + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals Tier 5 - Specialty ✓ — — PA
AmeriHealth Caritas Next Bronze Premier + No Referrals Tier 5 - Specialty ✓ — — PA
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 10 hours, 50 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Provider Partners North Carolina Advantage Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 3 per 84 days PA | QL
Provider Partners North Carolina Community Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 3 per 84 days PA | QL
Provider Partners North Carolina Essential Plan (HMO I-SNP) Tier 1 - Preferred Generic ✓ — ✓ 3 per 84 days PA | QL
AmeriHealth Caritas VIP Care (HMO D-SNP) Tier 3 - Preferred Brand ✓ — ✓ 0.5 per 28 days PA | QL
Troy Medicare (HMO) Tier 3 - Preferred Brand ✓ — ✓ 0.5 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
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Signature Giveback (PPO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Chronic Care (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Chronic Care Value (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
HealthSpring True Choice (PPO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
HealthSpring TotalCare (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
HealthSpring TotalCare Plus (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
HealthSpring Preferred (HMO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
HealthSpring Preferred Select (HMO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
HealthSpring Preferred Savings (HMO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
HealthSpring Preferred Plus (HMO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED DUAL FULL 013 NC (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED DUAL PLUS 006 NC (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED DUAL 009 NC (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED CORE 001 NC (HMO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED GIVEBACK 002 NC (HMO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED GIVEBACK 012 NC (HMO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED CHOICE 001 NC (PPO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 002 NC (PPO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED CHOICE 003 NC (PPO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 004 NC (PPO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED CHOICE 005 NC (PPO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 006 NC (PPO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED CHOICE 008 NC (PPO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
DEVOTED CHOICE GIVEBACK 009 NC (PPO) Tier 5 - Specialty ✓ — ✓ 0.5 per 28 days PA | QL
HealthTeam Advantage Plan I (PPO) Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
HealthTeam Advantage Plan II (PPO) Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
HealthTeam Advantage Vitality Plan (PPO) Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 3 per 84 days PA | QL
Humana Gold Plus H1036-137 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H1036-233 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Dual Select H1036-307 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H1036-335 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice Giveback H5216-017 (PPO) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice H5216-211 (PPO) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Full Access H5525-034 (PPO) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice Giveback H5525-035 (PPO) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice H5525-049 (PPO) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice H5525-050 (PPO) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice H5525-070 (PPO) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Dual Select H5525-072 (PPO D-SNP) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
HumanaChoice H5525-083 (PPO) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H6622-025 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H6622-026 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H6622-057 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Aetna Medicare Signature (HMO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Humana Gold Plus H6622-061 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Choice H8145-004 (PFFS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Humana Gold Plus H6622-060 (HMO-POS) Tier 5 - Specialty ✓ — ✓ 1.5 per 84 days PA | QL
Aetna Medicare Dual (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Signature (HMO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Value Plus (HMO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Prime (HMO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Signature Care (HMO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Full Dual Care (HMO D-SNP) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Enhanced (HMO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Enhanced (PPO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Enhanced (PPO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Signature Extra (PPO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
Aetna Medicare Signature (PPO) Tier 5 - Specialty ✓ — ✓ 0.50 per 28 days PA | QL
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