We’re changing how we manage Stelara, Stelara biosimilar therapies for most commercial members, starting April 1, May 1

Yesintek™ (ustekinumab-kfce) will be the preferred ustekinumab product for most Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial members, as follows:

• When covered under pharmacy benefits, this change will be effective for dates of service on or after April 1, 2025.
• When covered under medical benefits, this change will be effective for dates of service on or after May 1, 2025.

Members on a plan using the Preferred Drug List are excluded from this change. This change doesn’t apply to Medicare Advantage groups or members.

In addition, for dates of service on or after May 1, 2025, the subcutaneous, or SC, formulations of ustekinumab will no longer be payable under the member’s medical benefit. Members who continue to receive SC ustekinumab administered by a health care provider (billed under medical benefits) on or after May 1 may be responsible for the full cost.

How this will affect members under pharmacy benefits

Authorizations for Stelara SC, brand ustekinumab, will remain in effect until March 31, 2025. New authorizations for Yesintek SC will be approved April 1, 2025, and active through March 31, 2026, so members can continue therapy without interruption. If members decide to use Stelara SC on or after April 1, they’ll be responsible for the full cost.

Filling the prescription

We’ll only pay for Yesintek SC when filled through Walgreens Specialty Pharmacy, an independent company that provides specialty pharmacy services to Blue Cross and BCN.

Members who are currently filling Stelara SC prescriptions at the Michigan Medicine Specialty Pharmacy may continue filling Yesintek SC there.

If members are currently filling Stelara SC through Walgreens:

• Walgreens Specialty Pharmacy will obtain a new prescription for Yesintek SC from their doctor, if needed.
• Walgreens Specialty Pharmacy will fill the prescription with Yesintek SC on or after April 1. 

If members are currently filling their prescriptions through a pharmacy other than those mentioned above:

• A representative from Walgreens Specialty Pharmacy will be calling the member to set up a profile.
• Walgreens Specialty Pharmacy will obtain a new prescription for Yesintek SC from their doctor.

Prescribers can send a new prescription for Yesintek SC by one of the following methods:

How this will affect members under medical benefits

The nonpreferred ustekinumab products are Imuldosa™, Otulfi™, Pyzchiva^®, Selarsdi™, Stelara^®, Steqeyma^® and Wezlana™.

Members who have active authorizations for the IV formulation of Yesintek won’t be affected by this change.

Members who have active authorizations for a nonpreferred ustekinumab product or SC ustekinumab product are authorized to continue their current therapy under medical benefits through April 30, 2025.

We’re issuing authorizations for Yesintek SC under pharmacy benefits from May 1, 2025, to April 30, 2026, to avoid any interruptions in care.

• Proactive authorizations for preferred therapy under pharmacy benefits will be issued only for members who have their pharmacy benefit through Blue Cross or BCN.
• Members who don’t have prescription coverage through Blue Cross or BCN and are currently filling their prescription through their medical benefits will need a new prescription with a prior authorization through their pharmacy provider.

To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.

How to submit prior authorization requests

For a self-administered ustekinumab SC product (covered under pharmacy benefits), submit the request using an electronic prior authorization, or ePA, tool such as CoverMyMeds^® or Surescripts^®.

For an ustekinumab IV product that requires administration by a health care provider (covered under medical benefits), submit the request through the NovoLogix^® online tool.

NovoLogix^® is an independent company that provides an online prescription drug prior authorization tool for Blue Cross Blue Shield of Michigan and Blue Care Network.

Walgreens Specialty Pharmacy is an independent company that provides specialty pharmacy services covered under the pharmacy benefit for various Blue Cross Blue Shield of Michigan and Blue Care Network members with commercial plans.