Prior authorization required
Does Aetna (CVS Health) require prior authorization for Stelara?
Aetna (CVS Health) requires prior authorization for Stelara on every Medicare Part D plan of theirs that covers it.
Every plan from this payer that covers the drug requires authorization before it is dispensed.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| 0.5 ML ustekinumab 90 MG/ML Injection [Stelara]1654079 | 653 / 658 | 653 | 0 | 653 | Prior authorization required |
| 0.5 ML ustekinumab 90 MG/ML Prefilled Syringe [Stelara]853354 | 653 / 658 | 653 | 0 | 653 | Prior authorization required |
| 1 ML ustekinumab 90 MG/ML Prefilled Syringe [Stelara]853356 | 653 / 658 | 653 | 0 | 653 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 0.5 ML ustekinumab 90 MG/ML Injection [Stelara]
Stelara has 3 products in the corpus; this table is for 0.5 ML ustekinumab 90 MG/ML Injection [Stelara], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Aetna Community HealthChoices (HMO D-SNP) | H3959-069 | 5 | Yes | No | Yes |
| Aetna Community HealthChoices (HMO D-SNP) | H3959-070 | 5 | Yes | No | Yes |
| Aetna Community HealthChoices (HMO D-SNP) | H3959-071 | 5 | Yes | No | Yes |
| Aetna Community HealthChoices (HMO D-SNP) | H3959-072 | 5 | Yes | No | Yes |
| Aetna Community HealthChoices (HMO D-SNP) | H3959-073 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra (PPO) | H1608-029 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra (PPO) | H7301-002 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Dual (HMO D-SNP) | H1692-005 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Dual (HMO D-SNP) | H3959-036 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Dual Care (HMO D-SNP) | H3959-035 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Elite (HMO) | H1692-003 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Enhanced (HMO-POS) | H3959-001 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Enhanced (HMO-POS) | H3959-039 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Enhanced (PPO) | H1608-027 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Extra (PPO) | H7301-006 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Premier (HMO-POS) | H3959-002 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Premier (PPO) | H5522-002 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Premier (PPO) | H5522-014 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Prime Plus (HMO-POS) | H3959-053 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO-POS) | H3959-010 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO-POS) | H3959-037 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO-POS) | H3959-052 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO) | H1692-002 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (HMO) | H3959-055 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (PPO) | H1608-040 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature (PPO) | H5522-004 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature Giveback (PPO) | H1608-031 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature Giveback (PPO) | H5522-017 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature Plus (HMO-POS) | H3959-011 | 5 | Yes | No | Yes |
| Aetna Medicare Advantra Signature Plus (HMO-POS) | H3959-032 | 5 | Yes | No | Yes |
| Aetna Medicare Carilion Health Prime (HMO-POS) | H3931-158 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H0628-036 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H0628-037 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H0628-038 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H0628-039 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-080 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-081 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-082 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-083 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-084 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-085 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H1609-094 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H2663-098 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H2663-100 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H2663-102 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3146-037 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3146-038 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3192-033 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3239-030 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3312-091 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3931-191 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3959-076 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H3959-084 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (HMO C-SNP) | H5302-026 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care (PPO C-SNP) | H2293-035 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-031 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-032 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-033 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-034 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H0628-035 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H2663-099 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H3146-036 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H3192-028 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H3192-029 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Total (HMO C-SNP) | H3959-083 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | H3146-044 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | H3959-074 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | H3959-075 | 5 | Yes | No | Yes |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | H3959-085 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H3146-002 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H4711-013 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H5325-004 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H5325-005 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (HMO D-SNP) | H5325-006 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (PPO D-SNP) | H1608-062 | 5 | Yes | No | Yes |
| Aetna Medicare Dual (PPO D-SNP) | H1608-077 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H0628-013 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H3239-010 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H3239-012 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H3239-023 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H4711-012 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H5302-020 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H5325-003 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H5593-001 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H7149-006 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H8597-001 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H8597-002 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (HMO D-SNP) | H8597-003 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (PPO D-SNP) | H2293-004 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (PPO D-SNP) | H3288-053 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (PPO D-SNP) | H5521-465 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Care (PPO D-SNP) | H5521-472 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra (HMO D-SNP) | H3239-005 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra (PPO D-SNP) | H1608-076 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra (PPO D-SNP) | H2293-021 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3239-001 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3239-002 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3239-007 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3239-015 | 5 | Yes | No | Yes |
| Aetna Medicare Dual Extra Care (HMO D-SNP) | H3931-175 | 5 | Yes | No | Yes |
Showing 100 of 653 covering plans.
Source
Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Stelara at other payers
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.