Diagnosis: Psoriasis
Issur under review: Stelara

Determination:
Stelara is medically necessary.

The current treatment guidelines, which are in accordance with nationally accepted standards of medical practice for moderate to severe plaque psoriasis, recommend typical first line treatments such as topical corticosteroids and calcipotriene, followed by typical second line treatments, such as ultraviolet phototherapy, oral systemic treatments (methotrexate, cyclosporine) and biologics. The patient has failed topical therapy, phototherapy, and systemic therapy with methotrexate.

Stelara (ustekinumab) is indicated for the treatment of adult patients with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy, and is therefore medically necessary in this patient.