Bimzelx (bimekizumab-bkzx) — CareFirst (Caremark)

moderate to severe hidradenitis suppurativa (HS)

Initial criteria

Member is an adult (age ≥ 18 years) with moderate to severe hidradenitis suppurativa.
Authorization of 12 months may be granted for members who have previously received a biologic indicated for moderate to severe HS.
Authorization of 12 months may be granted when either of the following is met:
• Member has had an inadequate response to an oral antibiotic used for the treatment of HS for at least 90 days (e.g., clindamycin, metronidazole, moxifloxacin, rifampin, tetracyclines).
• Member has intolerance or contraindication to oral antibiotics used for HS.
Negative TB test documented if biologic naïve.
Member cannot use Bimzelx concomitantly with another biologic or targeted synthetic drug for the same indication.

Adult member demonstrates positive clinical response evidenced by low disease activity or improvement in signs/symptoms when any of the following is met:
• Reduction in abscess and inflammatory nodule count from baseline
• Reduced formation of new sinus tracts and scarring
• Decrease in frequency of inflammatory lesions from baseline
• Reduction in pain from baseline
• Reduction in suppuration from baseline
• Improvement in frequency of relapses from baseline
• Improvement in quality of life from baseline
• Improvement on a disease severity assessment tool from baseline.

12 months