Claim in ustekinumab, Stelara begins to surface in State

Psoriasis is a chronic disorder of the skin characterized by reddish,
scaly patches of inflammation, most commonly affecting the elbows,
knees, scalp, and/or groin.Psoriasis can be mild or severe. When it is
severe, it can adversely affect functions of daily living including
work and social activities.
Psoriasis has been reported to affect approximately 2% of the world's
population.
GENERIC NAME: ustekinumab
BRAND NAME: Stelara
DRUG CLASS AND MECHANISM: Ustekinumab is an injectable biologic drug
that suppresses the immune system and is used for the treatment of
psoriasis . It is an antibody that binds to interleukin (IL)-12 and
IL-23, two chemicals produced by cells in the body that stimulate
immune reactions. Scientists believe that psoriasis is caused by an
increase in the production of T-lymphocytes in response to the
attachment of a stimulant, such as interleukin, to the lymphocyte.
Stimulated T-lymphocytes cause skin cells to grow rapidly, and the
rapid growth of the skin cells produces the skin plaques of psoriasis.
Ustekinumab reduces symptoms of psoriasis (inflammation and excessive
production of skin cells) by attaching to IL-12 and IL-23, preventing
them from binding and activating T-lymphocytes. In scientific studies,
59% to 73% of patients received an assessment ofcleared or minimal
psoriasis after 12 weeks of treatment.
SIDE EFFECTS: The most common side effects of ustekinumab are
tiredness, upper respiratory tract infections , and headaches .
Ustekinumab may reduce the abilitythe immune system to fight
infections, increasing the risk of infections such as tuberculosis
(TB), and infections caused by bacteria, fungi, or viruses.
Ustekinumab also may increase therisk of certain types of cancer and
cause posterior leukoencephalopathy syndrome (RPLS). RPLS is a rare
condition that affects the brain and can cause death. The cause is
unknownbut if detected early and treated, most people recover.
Symptoms may include headache , seizures , confusion , and vision
problems.
Psoriasis is a long-term skin condition that may cause large plaques
of red, raised skin, flakes of dry skin, and skin scales.
Procedures & Tests 0 articles
but mandate in process ustekinumab, Stelara APPLICABLE TENNESSEE STATE
MANDATE REQUIREMENTS
Tennessee State law requires coverage of off-label indications of Food
and Drug Administration (FDA)approved drugs when the off-label use is
relative to life-threatening illnesses, such as cancer, AIDS, and
coronary heart disease and recognized in one of the standard reference
compendia (As defined in the statute: The United States Pharmacopoeia
Drug Information, The American Medical Association Drug Evaluations, &
The American Hospital Formulary Service Drug Information) or in the
medical literature. This law is applicable to all fully insured
members. The law is not applicable to self-funded accounts, but
coverage for off-label uses may be provided based on the contractual
agreement.

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