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The Policy VaultThe Policy Vault

Bimzelx — Cigna

Hidradenitis Suppurativa

Initial criteria

  • Patient meets the standard Inflammatory Conditions – Bimzelx Prior Authorization Policy criteria
  • Patient is currently receiving Bimzelx AND has been established on therapy for at least 90 days with verification in claims history OR meets trial criteria for indicated condition (Ankylosing Spondylitis: tried one of Enbrel, an adalimumab product, or Taltz; Hidradenitis Suppurativa: tried one of an adalimumab product or Cosentyx subcutaneous; nr-axSpA: tried one of Cimzia or Taltz; Plaque Psoriasis or Psoriatic Arthritis: tried ONE of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, Sotyktu, an ustekinumab subcutaneous product, Taltz, or Tremfya subcutaneous)

Reauthorization criteria

  • Patient continues to meet the standard Inflammatory Conditions – Bimzelx Prior Authorization Policy criteria

Approval duration

1 year