#SFHS2608372AOrder of April 8, 2026, amending the list of pharmaceutical specialties approved for use by communities and various public services
AI-generated summary for informational purposes only. Not legal advice. See the original source for the authoritative text.
The law updates the list of pharmaceutical specialties approved for use by public entities, including specific treatments for certain chronic conditions like psoriasis, psoriatic arthritis, and Crohn's disease. This means that the listed drugs are now recognized for insurance claims if prescribed for these conditions, affecting healthcare providers, insurance companies, and patients needing these medications.
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Key Changes
- Two new pharmaceutical specialties added
- Specific conditions for psoriasis, psoriatic arthritis, and Crohn's disease covered
- Insurance coverage recognition for listed medications
Obligations
What this law requires
Healthcare providers must ensure YESINTEK (ustekinumab) 45 mg and 90 mg are only prescribed for plaque psoriasis in adults when there has been failure, contraindication, or intolerance to other systemic treatments including ciclosporine, methotrexate, or psoralene/UVA therapy
Healthcare providers must restrict YESINTEK (ustekinumab) prescriptions for psoriatic arthritis to monotherapy or combination with methotrexate only when previous non-biologic DMARD treatment has been inadequate or contraindicated
Healthcare providers must ensure YESINTEK (ustekinumab) for Crohn's disease is prescribed only to adult patients with moderate to severe active disease who have failed conventional treatment (corticosteroids or immunosuppressants) and at least one anti-TNFα agent, or have contraindications to such agents
Healthcare providers must restrict pediatric plaque psoriasis treatment with YESINTEK (ustekinumab) to children and adolescents aged 6 years and older with moderate to severe disease showing insufficient response or intolerance to other systemic treatments or phototherapies
Insurance companies must recognize YESINTEK (ustekinumab) with CIP codes 34009 303 335 1 8 (45 mg) and 34009 303 335 2 5 (90 mg) as approved for insurance reimbursement when prescribed within the specified therapeutic indications