Bimzelx (bimekizumab-bkzx) — CareFirst (Caremark)

moderate to severe plaque psoriasis (PsO)

Initial criteria

Member is an adult (age ≥ 18 years) with moderate to severe plaque psoriasis.
Authorization of 12 months may be granted for members who have previously received a biologic or targeted synthetic drug (e.g., Sotyktu, Otezla) indicated for treatment of moderate to severe plaque psoriasis.
Authorization of 12 months may be granted when any of the following criteria is met:
• Crucial body areas (e.g., hands, feet, face, neck, scalp, genitals/groin, intertriginous areas) are affected.
• At least 10% of body surface area (BSA) is affected.
• At least 3% of BSA is affected AND member has had an inadequate response or intolerance to either phototherapy (e.g., UVB, PUVA) or pharmacologic treatment with methotrexate, cyclosporine, or acitretin, OR has a clinical reason to avoid those therapies.
Member has a documented negative tuberculosis (TB) test within 12 months of initiating therapy if naïve to biologic or targeted synthetic drugs associated with increased TB risk.
Member cannot use Bimzelx concomitantly with any other biologic drug or targeted synthetic drug for the same indication.

Adult member who is using Bimzelx for moderate to severe plaque psoriasis shows positive clinical response evidenced by low disease activity or improvement in signs/symptoms when either:
• Reduction in BSA affected from baseline, OR
• Improvement in signs and symptoms from baseline (e.g., itching, redness, flaking, scaling, burning, cracking, pain).

12 months