Bimzelx (bimekizumab-bkzx) — CareFirst (Caremark)
active ankylosing spondylitis (AS)
Initial criteria
- Member is an adult (age ≥ 18 years) with active ankylosing spondylitis or active non-radiographic axial spondyloarthritis.
- Authorization of 12 months may be granted for members who have previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated for active AS or nr-axSpA.
- Authorization of 12 months may be granted when either of the following is met:
- • Member has had an inadequate response to at least two nonsteroidal anti-inflammatory drugs (NSAIDs).
- • Member has an intolerance or contraindication to two or more NSAIDs.
- Negative TB test documented if biologic naïve.
- Member cannot use Bimzelx concomitantly with any other biologic drug or targeted synthetic drug for the same indication.
Reauthorization criteria
- Adult member demonstrates positive clinical response with improvement in any of the following from baseline:
- • Functional status
- • Total spinal pain
- • Inflammation (e.g., morning stiffness)
- • Swollen joints
- • Tender joints
- • C-reactive protein (CRP).
Approval duration
12 months