Drug IndexStelara (ustekinumab)
Billing
Code: J3358
Description: Ustekinumab, iv inject, 1 mg
Unit: 1 MG
Payment: $12.494
Pay quarter: Q2 2024
Covered in Part D: No
Drug Cost
Calculate drug cost and reimbursement
Total WAC:
$222.48Total Reimbursement:
$4,872.66(ASP: $4,596.85, Margin: $275.81)
.
.# Units to bill:
390Dosage & Frequency
Psoriasis (Ps)
For adult patients (age 18 or older)
• 45mg SQ if patient weighs less than or equal to 100kg
• 90mg SQ if patient weighs greater than 100kg
For pediatric patients (age 6-17)
• 0.75mg/kg if patient weighs less than 60kg
• 45mg if patient weighs 60-100kg
• 90mg if patient weighs greater than 100kg
Induction:
• at weeks 0 and 4
Maintenance:
• every 12 weeks
For adult patients (age 18 or older)
• 45mg SQ if patient weighs less than or equal to 100kg
• 90mg SQ if patient weighs greater than 100kg
For pediatric patients (age 6-17)
• 0.75mg/kg if patient weighs less than 60kg
• 45mg if patient weighs 60-100kg
• 90mg if patient weighs greater than 100kg
Induction:
• at weeks 0 and 4
Maintenance:
• every 12 weeks
Psoriatic Arthritis (PsA)
• 45mg SQ
• 90mg SQ if patient weighs greater than 100kg with co-existent moderate-to-severe plaque psoriasis
Induction:
• at weeks 0 and 4
Maintenance:
• every 12 weeks
• 45mg SQ
• 90mg SQ if patient weighs greater than 100kg with co-existent moderate-to-severe plaque psoriasis
Induction:
• at weeks 0 and 4
Maintenance:
• every 12 weeks
Crohn's Disease (CD)
Ulcerative Colitis
Induction:
• 250mg IV if patient weighs less than or equal to 55kg
• 390mg IV if patient weighs 55-85kg
• 520mg IV if patient weighs greater than 85kg
Maintenance:
• 90mg SQ every 8 weeks
Ulcerative Colitis
Induction:
• 250mg IV if patient weighs less than or equal to 55kg
• 390mg IV if patient weighs 55-85kg
• 520mg IV if patient weighs greater than 85kg
Maintenance:
• 90mg SQ every 8 weeks
Billable NDCs
57894-0054-27
STELARA (IV Infusion) (JANSSEN BIOTECH, INC.)
130 MG
Prior Authorization
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