ustekinumab-srlf
Generic: Imuldosa
45 mg/0.5 mL, 90 mg/mL — Prefilled Syringe
TARGETED IMMUNOMODULATORY BIOLOGICS
Also known as:
IMULDOSA
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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)
34 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Complete Gold
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze with Atrium Health
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced Asthma/COPD Care Silver $0 Rx Options + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Expanded Bronze with Atrium Health + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Silver with Atrium Health + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Signature Gold with Atrium Health + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Clear Silver with $0 Insulin Options + Vision + Adult Dental
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Streamlined Silver with Atrium Health
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Enhanced CHF Heart Care Silver $0 Rx Options
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Imuldosa |
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 Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Imuldosa |
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 Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Bronze RD 6000 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD CMS Standard
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 3500 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 5000 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD CMS Standard
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold RD CMS Standard
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 5000 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Silver
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold 1500 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 5500 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 6500 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3600 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3000 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze CMS Standard
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver CMS Standard
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold CMS Standard
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Bronze
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
Medicare Part D
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Imuldosa |
Tier 3 - Preferred Brand | ✓ | — | ✓ 0.5 per 28 days | PA | QL |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Imuldosa |
Tier 3 - Preferred Brand | ✓ | — | ✓ 0.5 per 28 days | PA | QL |
|
Troy Medicare (HMO)
via Imuldosa |
Tier 3 - Preferred Brand | ✓ | — | ✓ 0.5 per 28 days | PA | QL |