MaxorPlus Formulary Update: Stelara® Biosimilar

Our formulary list is changing this year. We are moving to a biosimilar for Stelara®, a frequently prescribed medication for Crohn’s disease, ulcerative colitis, plaque psoriasis, and psoriatic arthritis. This is part of the overall biosimilars strategy at MaxorPlus, which is an effort to look out for value, member choice, and cost savings for our clients and members. 

For members new to therapy, Stelara is targeted for removal from the Advantage and Focus formularies starting July 1, 2025. For existing utilizers and everyone else, Stelara is targeted for removal from the Advantage and Focus formularies starting January 1, 2026.

There are benefits to using biosimilars:

• With no clinically meaningful difference from reference products, interchangeable biosimilars are a safe and effective treatment option that may reduce plan and member costs.
• Moving to biosimilars allows members to have choices over which biosimilar products may best meet their healthcare needs, a decision made in coordination with their prescribing physician.

For members new to therapy or existing utilizers of Stelara, there will be FDA-approved interchangeable biosimilar options once they become available. Select manufacturers will be available in 2025 on each of the Advantage, Focus, and Preferred formularies. Account teams will share details as new products are added.

We will be updating our prior authorization criteria to reflect the formulary changes for 2025 and 2026. This is a dynamic situation where market conditions may change rapidly. MaxorPlus will provide updates and guidance accordingly.

To learn more about MaxorPlus, please visit https://www.maxor.com/maxorplus/.