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Limited coverage criteria – ustekinumab for plaque psoriasis

Last updated on August 5, 2026

 

Return to Special Authority drug list

Generic name

ustekinumab

Brand

Strength

Form
Otulfi® 45 mg/0.5 mL pre-filled, single-use syringe for subcutaneous injection
90 mg/1 mL pre-filled, single-use syringe for subcutaneous injection
Jamteki™ 45 mg/0.5 mL pre-filled, single-use syringe for subcutaneous injection
90 mg/1 mL pre-filled, single-use syringe for subcutaneous injection
Pyzchiva® 45 mg/0.5 mL pre-filled, single-use syringe for subcutaneous injection
90 mg/1 mL pre-filled, single-use syringe for subcutaneous injection
Steqeyma® 45 mg/0.5 mL pre-filled, single-use syringe for subcutaneous injection
90 mg/1 mL pre-filled, single-use syringe for subcutaneous injection
Wezlana™ 45 mg/0.5 mL pre-filled, single-use syringe for subcutaneous injection
45 mg/0.5 mL pre-filled, single-use autoinjector for subcutaneous injection
90 mg/1 mL pre-filled, single-use syringe for subcutaneous injection
90 mg/1 mL pre-filled, single-use autoinjector for subcutaneous injection
Yesintek™ 45 mg/0.5 mL pre-filled, single-use syringe for subcutaneous injection
90 mg/1 mL pre-filled, single-use syringe for subcutaneous injection

Special Authority criteria

Approval period

Initial

For the treatment of chronic moderate to severe plaque psoriasis (PsO) in adult patients 18 years of age and older who meet the ALL of the criteria: 

  •  Patient has a body surface area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet, or genital region

AND

  • Patient failed to respond, is intolerant, or is unable to access UV phototherapy

AND 

  • Patient has a baseline pre-biologic psoriasis area severity index (PASI) of ≥ 12 

AND

  •  Patient has had treatment failure1, intolerance, or a contraindication to methotrexate AND cyclosporine

AND 

  • Special Authority request submitted by a dermatologist

16 weeks

Initial renewal

  • Patient has attained a PASI of ≥ 75 from the baseline biologic naive PASI score

AND

  • Special Authority request submitted by a dermatologist

1 year

Second and subsequent renewals

  • Patient has maintained a PASI of ≥ 50 from the baseline biologic naive PASI score

AND

  • Special Authority request submitted by a dermatologist

1 year

Practitioner exemptions

  • None

Special notes

  • 1For treatment failure, an adequate trial is considered to be a continuous 3-month trial of methotrexate at a dose of 20 mg weekly (15 mg weekly for ages >65), AND cyclosporine 4 mg/kg/day
  • PharmaCare coverage will not be provided for ustekinumab in combination with other biologic drugs for the treatment of PsO in adults
  • PharmaCare covers a maximum 84-day supply per fill of ustekinumab
  • Additional information expected to assist with processing of coverage requests is detailed on the forms linked below (and on the eForms published online)

Special Authority request form(s)