Cigna Ustekinumab (Stelara) prior authorization requirements (2026)
What Cigna generally requires to approve Ustekinumab (Stelara) (CPT J3357, J3358), for Commercial plans. Yes. Cigna generally requires prior authorization for Ustekinumab (Stelara) (CPT J3357, J3358).
Medical-necessity criteria Cigna generally applies
Prior authorization required (prescribed by/with a gastroenterologist); preferred ustekinumab products must be used first. Crohn's disease (age 2 or older) or ulcerative colitis (age 18 or older), moderate-to-severe. The IV product (J3358) is induction only - a single weight-based IV dose (CD/UC: 55 kg or less up to 260 mg; over 55-85 kg up to 390 mg; over 85 kg up to 520 mg) followed by subcutaneous maintenance (J3357) 8 weeks later. IV induction approvals are issued for 30 days.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Ustekinumab (Stelara). Confirm the covered diagnosis list against the current Cigna policy.
Commonly required documentation
- Diagnosis (moderate-to-severe CD or UC)
- weight for IV induction dose
- specialist prescriber.
Situations to verify before submitting
Cigna may not cover Ustekinumab (Stelara) in these situations. Verify against the current policy rather than assuming a denial:
- Should not be administered in combination with another biologic or a targeted synthetic oral small-molecule drug
How to submit
- Method: Cigna / Express Scripts prior authorization
- Portal: Cigna Provider (CHCP)
Source
Source: Cigna Coverage Policy IP0686 Ustekinumab Intravenous (eff 2026-05-15). Codes J3357 (SC), J3358 (IV). Aetna and UHC ustekinumab policies exist but were not verified this pass. Last verified 2026-06-17.
Frequently asked questions
Does Cigna require prior authorization for Ustekinumab (Stelara)?
Yes. Cigna generally requires prior authorization for Ustekinumab (Stelara) (CPT J3357, J3358).
What does Cigna require to approve Ustekinumab (Stelara)?
Prior authorization required (prescribed by/with a gastroenterologist); preferred ustekinumab products must be used first. Crohn's disease (age 2 or older) or ulcerative colitis (age 18 or older), moderate-to-severe. The IV product (J3358) is induction only - a single weight-based IV dose (CD/UC: 55 kg or less up to 260 mg; over 55-85 kg up to 390 mg; over 85 kg up to 520 mg) followed by subcutane… Always confirm against the current Cigna policy.
How long does a Cigna prior authorization take?
Turnaround varies by plan and submission method. Check the Cigna portal for current timeframes.
Submitting Ustekinumab (Stelara) to Cigna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.