$49$0.99

Does UPMC Health Plan Cover Stelara

Explore UPMC Health Plan coverage for Stelara: reasons for denial, ways to secure approval, pricing without insurance, and answers to common questions.

Treat your allergies with Curex

as seen on

“Curex is changing the landscape of allergies in 2024”

Coverage for Stelara Under UPMC Health Plan

Stelara, a medication used for treating psoriatic arthritis, plaque psoriasis, and Crohn's disease, may be covered by UPMC Health Plan, but coverage depends on specific benefit plans and medical necessity.

Prior authorization is typically required. Your healthcare provider must demonstrate that Stelara is medically necessary and that other treatments may not be effective for your condition.

Eligibility usually includes documented evidence of diagnosis, severity of illness, and prior treatment history. Confirm these with your healthcare provider before starting the treatment process.

For full coverage details, consult the list of covered drugs in your plan's formulary and speak directly with UPMC Health Plan's member services for personal guidance based on your policy.

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49 $9.99

Review your allergy test results with a Curex allergist.

Start Now

Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple. We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Stelara Coverage with UPMC Health Plan

Verify Your Stelara Prescription Eligibility

Contact your healthcare provider to ensure that Stelara is appropriate for your condition as per FDA guidelines.
Review UPMC Health Plan's formulary to ensure Stelara is listed as a covered medication for your specific health plan.
Discuss alternative medications if Stelara is not on your plan’s formulary or if there are therapeutic alternatives that need to be trialed first.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Stelara and its prescription requirements.
Request any necessary documentation or medical records that demonstrate your medical need for Stelara.
Your doctor may need to provide a letter of medical necessity to justify Stelara as the best treatment option.

Review Your UPMC Health Plan Benefits

Log into your UPMC Health Plan member portal to review your benefits and coverage specifics.
Check for any specific procedures or prior authorizations required for specialty medications like Stelara.
Contact UPMC Health Plan's customer service if you need clarification about your benefits or coverage limits.

Initiate Prior Authorization

Have your healthcare provider submit a prior authorization request to UPMC Health Plan, if required.
Ensure all necessary documentation, including the letter of medical necessity and relevant medical records, is included.
Follow up with your healthcare provider and UPMC Health Plan to confirm that all paperwork has been received and is in process.

Discuss Financial Assistance Options

Inquire about copay assistance programs offered by the manufacturer of Stelara or third-party organizations.
Assess if you qualify for any UPMC Health Plan financial assistance programs that could assist with medication costs.
Consider speaking with a UPMC Health Plan case manager for guidance on managing healthcare expenses.

Monitor the Approval Process

Stay in communication with your healthcare provider to receive updates on the status of your prior authorization request.
Respond promptly to any requests from UPMC Health Plan for additional information or documentation.
Keep track of all communication with UPMC Health Plan, including dates and names of representatives.

Fill Your Stelara Prescription

Once approved, choose an in-network pharmacy to fill your Stelara prescription to minimize out-of-pocket costs.
Coordinate with your pharmacy to understand any special handling or delivery requirements for Stelara.
Verify copay amounts with your pharmacy before filling the prescription to avoid unexpected costs.

Manage Ongoing Treatment

Schedule regular follow-ups with your healthcare provider to monitor the effectiveness of Stelara.
Report any side effects or concerns to your healthcare provider promptly to ensure timely management of any issues.
Review your treatment plan regularly with your healthcare provider to determine if adjustments are necessary.

Happy Customers

We love helping people!

Allie, Nevada

"I have two cats I can finally cuddle!"
‍

Cat and dog allergies

Zachary, Texas

“I can breathe through my nose for the first time in like 20 years!"

Dust and mold allergies

Erika, New York

“I've noticed less sneezing and shortness of breath.”

Tree and grass allergies

Richard, Texas

I love the convenience!
‍

Tree and cat allergies

We Treat Allergies

Food Allergies

Weed Pollens

Cat Allergies

Dog Allergies

Dust Mites

Molds

Tree Pollens

curex user showing allergy treatment kit

a male patient showing allergy drops vial

50,000+ users have overcome their allergies

Am I eligible?

At-home Immunotherapy

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option

Treatment prescribed
by clinician

Clinicaly made allergen extracts are customized for your allergies

Your immune system gets desensitized to allergens, giving you long-term relief.

FAQs

Does UPMC Health Plan Cover Stelara

Explore UPMC Health Plan coverage for Stelara: reasons for denial, ways to secure approval, pricing without insurance, and answers to common questions.

Achieve Your Goals Faster with Curex

Is Stelara Covered by UPMC Health Plan

Coverage for Stelara Under UPMC Health Plan

Stelara, a medication used for treating psoriatic arthritis, plaque psoriasis, and Crohn's disease, may be covered by UPMC Health Plan, but coverage depends on specific benefit plans and medical necessity.

Prior authorization is typically required. Your healthcare provider must demonstrate that Stelara is medically necessary and that other treatments may not be effective for your condition.

Eligibility usually includes documented evidence of diagnosis, severity of illness, and prior treatment history. Confirm these with your healthcare provider before starting the treatment process.

For full coverage details, consult the list of covered drugs in your plan's formulary and speak directly with UPMC Health Plan's member services for personal guidance based on your policy.

A weight management program tailored to you

Start with Curex

UPMC Health Plan's Approved Criteria for Stelara Coverage

Criteria for Coverage of Stelara

**Diagnosis of Moderate to Severe Plaque Psoriasis**
- Patient must be 18 years of age or older.
- Documentation of at least 10% of Body Surface Area (BSA) affected or significant involvement of the face, palms, soles, or genitals.
- Previous failure with or contraindication to, or intolerance of one or more traditional therapies such as methotrexate, cyclosporine, or phototherapy.
**Diagnosis of Active Psoriatic Arthritis**
- Patient must be 18 years of age or older.
- Documented evaluation and diagnosis of active psoriatic arthritis.
- Evidence of inadequate response to at least one Disease-Modifying Anti-Rheumatic Drug (DMARD) such as methotrexate or leflunomide.

**Diagnosis of Moderate to Severe Crohn's Disease**
- Patient must be 18 years of age or older.
- Documented diagnosis of moderate to severe Crohn's disease as confirmed by a gastroenterologist.
- Inadequate response, lost response, or intolerance to one or more conventional therapies including corticosteroids or immunomodulators, or anti-TNF agents.

**Diagnosis of Moderate to Severe Ulcerative Colitis**
- Patient must be 18 years of age or older.
- Documented diagnosis of moderate to severe ulcerative colitis confirmed by gastroenterological evaluation.
- Demonstrated failure or intolerance to one or more standard therapies such as corticosteroids, azathioprine, 6-mercaptopurine, or anti-TNF agents.

**Specialist Consultation and Evaluation**
- Specialist physician involvement in the patient's diagnosis and treatment.
- Documentation should include assessment and utilization of treatment protocols established by a dermatologist, rheumatologist, or gastroenterologist, as appropriate to the condition.

Why UPMC Health Plan Might Deny Stelara Coverage

Reasons for Stelara Coverage Denial

Failure to meet specific diagnostic criteria as outlined by UPMC Health Plan for conditions like psoriasis, psoriatic arthritis, or Crohn’s disease.

Lack of adequate documentation from healthcare providers demonstrating the patient's medical necessity for Stelara.

The patient did not try and fail or has contraindications to less costly treatment options available before considering Stelara, unless otherwise clinically justified.

Patient's age does not fall within the approved age range specified in the formulary guidelines for Stelara.

Presence of specific contraindications or warnings that make Stelara unsafe for the patient, as identified in the prescribing information.

The patient's treatment is outside the approved dosage or frequency parameters set by the UPMC Health Plan for Stelara.

Stelara is being requested for an off-label use that is not supported by substantial clinical evidence or does not comply with the UPMC's policy on investigational drugs.

Stelara is not covered under the patient’s specific insurance plan due to plan exclusions or benefit limitations related to biologics.

Failure to submit necessary prior authorization paperwork or required supporting documents within the stipulated time frame.

Continuing therapy does not show documented clinical improvement, aligning with UPMC's criteria for evaluating treatment efficacy.

Together with our partners we have changed the lives of over 300,000 patients.

Join Curex

How Much Does Stelara Cost without Insurance?

Approximate Cost of Stelara without Insurance

The price of Stelara, a medication used primarily for treating conditions such as psoriasis and Crohn's disease, can vary based on the pharmacy and other location-based factors, but without insurance, it typically costs around $20,000 to $40,000 per year.

Individual dosage needs and treatment plans can affect the total cost, as Stelara injections are spaced differently depending on treatment guidelines for specific conditions.

Pricing can also vary depending on the dosage strength; the standard doses are 45 mg and 90 mg, with the 90 mg dose generally being more expensive.

Patients can sometimes find manufacturer coupons or patient assistance programs that help reduce the cost of Stelara. These programs usually require an application process and eligibility criteria.

Additionally, discount pharmacy programs or third-party coupon providers might offer savings, although these are often limited and may vary in percentage or availability.

Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

Jill Hamburg, PA - C

Immunotherapy made simple. We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Kayla Mardaga, NP

How to Get Stelara Coverage with UPMC Health Plan

Verify Your Stelara Prescription Eligibility

Contact your healthcare provider to ensure that Stelara is appropriate for your condition as per FDA guidelines.
Review UPMC Health Plan's formulary to ensure Stelara is listed as a covered medication for your specific health plan.
Discuss alternative medications if Stelara is not on your plan’s formulary or if there are therapeutic alternatives that need to be trialed first.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Stelara and its prescription requirements.
Request any necessary documentation or medical records that demonstrate your medical need for Stelara.
Your doctor may need to provide a letter of medical necessity to justify Stelara as the best treatment option.

Review Your UPMC Health Plan Benefits

Log into your UPMC Health Plan member portal to review your benefits and coverage specifics.
Check for any specific procedures or prior authorizations required for specialty medications like Stelara.
Contact UPMC Health Plan's customer service if you need clarification about your benefits or coverage limits.

Initiate Prior Authorization

Have your healthcare provider submit a prior authorization request to UPMC Health Plan, if required.
Ensure all necessary documentation, including the letter of medical necessity and relevant medical records, is included.
Follow up with your healthcare provider and UPMC Health Plan to confirm that all paperwork has been received and is in process.

Discuss Financial Assistance Options

Inquire about copay assistance programs offered by the manufacturer of Stelara or third-party organizations.
Assess if you qualify for any UPMC Health Plan financial assistance programs that could assist with medication costs.
Consider speaking with a UPMC Health Plan case manager for guidance on managing healthcare expenses.

Monitor the Approval Process

Stay in communication with your healthcare provider to receive updates on the status of your prior authorization request.
Respond promptly to any requests from UPMC Health Plan for additional information or documentation.
Keep track of all communication with UPMC Health Plan, including dates and names of representatives.

Fill Your Stelara Prescription

Once approved, choose an in-network pharmacy to fill your Stelara prescription to minimize out-of-pocket costs.
Coordinate with your pharmacy to understand any special handling or delivery requirements for Stelara.
Verify copay amounts with your pharmacy before filling the prescription to avoid unexpected costs.

Manage Ongoing Treatment

Schedule regular follow-ups with your healthcare provider to monitor the effectiveness of Stelara.
Report any side effects or concerns to your healthcare provider promptly to ensure timely management of any issues.
Review your treatment plan regularly with your healthcare provider to determine if adjustments are necessary.

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

‍

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Stelara FAQ

What are the common side effects of Stelara?

Common Side Effects of Stelara

**Infections:** Increased susceptibility to infections such as upper respiratory infections and strep throat.
**Headache:** This is a frequently reported side effect among patients who use Stelara.
**Tiredness:** Many individuals may experience fatigue or tiredness while on this medication.
**Redness at Injection Site:** Skin irritation, including redness, itching, or swelling, can occur at the site of injection.
**Nausea:** Some patients report feeling mildly nauseated after taking the medication.

How does Stelara work for psoriasis?

Mechanism of Action

Stelara is a monoclonal antibody that targets interleukin-12 (IL-12) and interleukin-23 (IL-23), which are proteins involved in inflammatory processes associated with psoriasis.

Impact on the Immune System

By inhibiting IL-12 and IL-23, Stelara reduces the activity of specific immune cells (T-cells) that contribute to the inflammation and rapid skin cell production characteristic of psoriasis.

Clinical Efficacy

Many patients experience significant reductions in psoriasis symptoms, including skin clearance, with improvements often visible within weeks after initial treatment.

Administration and Dosage

Stelara is administered via subcutaneous injection, starting with a loading dose followed by maintenance doses every 12 weeks thereafter.

How often do you need Stelara injections?

Stelara Injection Schedule

Initial Doses: After the first dose is administered, a second dose follows four weeks later.

Maintenance Doses: Subsequent injections are given every 12 weeks.

Special Cases: Depending on specific conditions like Crohn's disease, the frequency may vary under a physician's guidance.

Administration: Stelara is typically administered as a subcutaneous injection which can be performed in a healthcare setting or self-administered after proper training.

Consult Your Doctor: Always consult with your healthcare provider to tailor the schedule to your medical needs.

Have questions left?

‍

Get a personalized online consultation with a doctor at Curex

Learn More

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”

Becky D.

"If I could give 6 stars, I would. BEST... BEST… BEST… service.”

Ferdian K.

“The Curex staff has been professional, efficient, and really focused on my individual needs.”

Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

Button Text

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide. Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Does UPMC Health Plan Cover Stelara

Explore UPMC Health Plan coverage for Stelara: reasons for denial, ways to secure approval, pricing without insurance, and answers to common questions.

Achieve Your Goals Faster with Curex