Limited coverage drugs – ustekinumab
Last updated on October 19, 2022
| Generic name | ustekinumab |
| Strength | 45 mg/0.5 mL and 90 mg/mL |
| Form | syringe |
|
Special Authority criteria |
Approval period |
|---|---|
| Treatment of moderate to severe psoriasis, according to established criteria, when prescribed by a dermatologist |
Initial: 3 doses |
Practitioner exemptions
- None
Special notes
- Established criteria are detailed in the SA request forms linked below.
Special Authority requests
- Log in to eForms
- HLTH 5380 Adalimumab/Etanercept/Infliximab/Ustekinumab for Moderate to Severe Psoriasis (PDF, 182KB)
- Psoriasis Area and Severity Index Worksheet (PDF, 539KB)