Effective Sept. 1, 2024, the Alliance will be implementing changes to the physician-administered drug benefit related to inflammatory bowel disease (IBD). The Pharmacy & Therapeutics (P&T) Committee has approved these changes.
Find prior authorization criteria on our webpage.
The changes are as follows:
| HCPCS Code | Drug | Change |
| J3357 | Ustekinumab (Stelara) – Subcutaneous | Prior authorization is required for the Alliance. |
| J3358 | Ustekinumab (Stelara) – Intravenous | Prior authorization is required for the Alliance. |
| Q5138 &
Q5137 |
Ustekinumab (Wezlana) Subcutaneous and Intravenous | New prior authorization criteria. |
| J1745
Q5121 Q5103 Q5104 |
Infliximab (Remicade)
Infliximab-axxq (Avsola) Infliximab-dyyb (Inflectra) Infliximab-abda (Renflexis) |
Modified prior authorization. |
| J3380 | Vedolizumab (Entyvio) | Modified prior authorization. |
| C9168 | Mirikizumab-mrkz (Omvoh) | New prior authorization criteria. |
| J2327 | Risankizumab-rzaa (Skyrizi) | New prior authorization criteria. |
If you have questions, please contact the Alliance Pharmacy Department at 831-430-5507.
