Expanded Coverage for STELARA® in Crohn’s Disease*

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Commercial Plan Medical IV Coverage Medical SubQ Coverage Pharmacy SubQ Coverage
ConnectiCare 1st Line Biologic 1st Line Biologic 1st Line Biologic
Contra Costa Health Plan Covered Covered Covered
County Medical Services Program (CMSP) Covered Covered Covered
Coventry Health Care 1st Line Biologic 1st Line Biologic 1st Line Biologic
Cox HealthPlans Covered Covered Biologic Trial Required
Crystal Run Health Plans Covered Covered Covered
CVS Caremark Advanced Control (Indication-Managed) N/A N/A Biologic Trial Required
CVS Caremark Performance - Standard Control (Drug-Managed) N/A N/A Biologic Trial Required
CVS Caremark Performance - Standard Opt Out (Copay-Managed) N/A N/A 1st Line Biologic
DAKOTACARE Covered Covered Covered
Dean Health Plan Biologic Trial Required Not Covered by Plan Biologic Trial Required
EmblemHealth 1st Line Biologic 1st Line Biologic Biologic Trial Required
Empire Blue Cross Blue Shield 1st Line Biologic 1st Line Biologic 1st Line Biologic
EnvisionRx Standard Formulary N/A N/A Biologic Trial Required
Excellus BlueCross BlueShield 1st Line Biologic 1st Line Biologic 1st Line Biologic
Express Scripts Covered Covered 1st Line Biologic
Fallon Health Biologic Trial Required Biologic Trial Required Biologic Trial Required
First Medical Health Plan Covered Covered Covered
FirstCare Health Plans Covered Covered Covered
FirstCarolinaCare N/A N/A Biologic Trial Required
Florida Blue 1st Line Biologic 1st Line Biologic 1st Line Biologic
Florida Health Care Plans Biologic Trial Required Biologic Trial Required Biologic Trial Required
Geisinger Health Plan Biologic Trial Required Biologic Trial Required Biologic Trial Required
Government Employees Health Association (GEHA) Covered Covered Biologic Trial Required
Group Health Cooperative of South Central Wisconsin (GHC-SCW) Covered Covered Covered
Gundersen Health Plan Covered Covered Covered
Harvard Pilgrim Health Care 1st Line Biologic 1st Line Biologic 1st Line Biologic
Hawaii Medical Assurance Association (HMAA) Covered Covered Covered
Hawaii Medical Service Association (HMSA) 1st Line Biologic 1st Line Biologic 1st Line Biologic
Health Advantage 1st Line Biologic 1st Line Biologic Biologic Trial Required

Need to verify more than one plan? View all national plans

Your One Source for Access, Affordability, and Treatment Support For Your Patients

Janssen CarePath helps verify insurance coverage for your patients, provides reimbursement information, helps find financial assistance options for eligible patients, and provides ongoing support to help them start and stay on STELARA® as prescribed.

Call a Janssen Care Coordinator at 877-CarePath (877-227-3728) Monday to Friday, 8 am to 8 pm ET

The information provided represents no statement, promise, or guarantee of Janssen Biotech, Inc., concerning levels of reimbursement, payment, or charge. Please consult your payer organization with regard to local or actual coverage, reimbursement policies, and determination processes. Information is subject to change without notice. Nothing herein may be construed as an endorsement, approval, recommendation, representation, or warranty of any kind by any plan or insurer referenced herein. This communication is solely the responsibility of Janssen Biotech, Inc.

Janssen CarePath | 877-CarePath (877-227-3728) Monday to Friday, 8 am to 8 pm ET

Quick Steps to Start STELARA

A step-by-step guide for prescribing STELARA® for Crohn's disease.

Download

Benefit Investigation and Prescription Form

Completing the Benefit Investigation and Prescription Form eliminates the need to write 2 prescriptions and perform 2 separate benefit investigations.

Download

Annotated Benefit Investigation and Prescription Form

Helpful instructions on how to fill out the Benefit Investigation and Prescription Form.

Download

Please note: Prior authorization may be required.

*First-line biologic: brand name drugs that do not require trial on another biologic product prior to utilization. Biologic trial required: brand name drugs that require trial on another biologic product prior to utilization. First-line biologic tier 2: brand-name drugs that are covered at a lower copayment, and/or with fewer restrictions, than higher-tiered brands in the same pharmacologic class.