Bimzelx (bimekizumab-bkzx) — CareFirst (Caremark)

Initial criteria

• Member is an adult (age ≥ 18 years) with active psoriatic arthritis.
• Authorization of 12 months may be granted for members who have previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Otezla) indicated for active psoriatic arthritis.
• Authorization of 12 months may be granted when either of the following is met:
• • Member has mild to moderate disease and meets one of the following:
• - Inadequate response to methotrexate, leflunomide, or another conventional synthetic drug (e.g., sulfasalazine) administered at adequate dose and duration.
• - Intolerance or contraindication to methotrexate, leflunomide, or another conventional synthetic drug.
• • Member has enthesitis or predominantly axial disease.
• • Member has severe disease.
• Member has a documented negative TB test within 12 months if biologic naïve.
• Member cannot use Bimzelx concomitantly with another biologic or targeted synthetic drug for the same indication.

Reauthorization criteria

• Adult member shows positive clinical response as evidenced by low disease activity or improvement in signs and symptoms when there is improvement in any of the following from baseline:
• • Number of swollen joints
• • Number of tender joints
• • Dactylitis
• • Enthesitis
• • Axial disease
• • Skin and/or nail involvement
• • Functional status
• • C-reactive protein (CRP).

Approval duration

12 months