​​​Effective January 1, 2026, Independence Blue Cross (IBX) will consider the following as self-administered drugs and therefore only covered under the Pharmacy Rx benefit.   

• Ustekinumab subcutaneous (SQ) administration (all brands including Stelara®, Yesintek, Wezlana®, Selarsdi®, Pyzchiva®, Steqeyma®).
• Vyvgart Hytrulo® (efgartigimod alfa and hyaluronidase-qvfc) subcutaneous (SQ) administration.

Transition details for Ustekinumab

IBX will notify all members who have received Ustekinumab SQ in the past 12 months by mail explaining how this change affects them. Members who previously transitioned from Stelara SQ to Yesintek SQ were also notified of this change prior to July 1, 2025.

For members who are new to treatment beginning January 1, 2026, Ustekinumab SQ will only be covered under the member's pharmacy benefit.  IBX will create new authorizations to address this change for all members with an existing prior authorization for Ustekinumab SQ who have both medical and pharmacy benefits. Medicare Advantage members are not affected by this change.

Current and future patients (members) who require an induction dose of Ustekinumab IV via provider infusion may continue to do so. This change does not impact intravenous induction dosing protocol or medical benefit coverage. 

Transition details for Vyvgart Hytrulo

IBX will mail letters to all members who have received Vyvgart Hytrulo in the past 12 months. The letter will explain how this change affects them. For members who are new to treatment as of January 1, 2026, Vyvgart Hytrulo will only be covered under the member's pharmacy benefit. Medicare Advantage members are not affected by this change.

Support for providers

Providers will be notified by mail with a list of IBX Commercial members who have been prescribed either drug in the past 12 months. Providers need to write prescriptions for the self-administered versions of these drugs. This allows the member's pharmacy benefit manager (PBM) to fulfill the request. Members who prefer not to self-administer can bring the drugs to the provider's office. IBX will reimburse providers for in-office administration.​​

For providers whose patients require a new prescription and have prescription drug coverage through Optum®, Optum Specialty Pharmacy® will contact these providers and members to support a successful transition. 

Optum Specialty Pharmacy® is an Optum company — an independent company that provides home delivery, specialty, and infusion pharmacy services.

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