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.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Imuldosa |
Tier 5 - Specialty | ✓ | — | — | PA |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 4400 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 3000 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 RD CMS Standard
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold CMS Standard
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD CMS Standard
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold RD CMS Standard
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 myDiabetesCare Silver
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold 1500 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Bronze
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 5500 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3500 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 Silver RD 3500 Indiv Med Deductible
via Imuldosa |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |