Bimzelx — Cigna

Initial criteria

• Patient age > 18 years
• Patient has objective signs of inflammation defined as at least ONE of the following: (a) C-reactive protein elevated beyond upper limit of normal OR (b) sacroiliitis reported on magnetic resonance imaging
• According to the prescriber, the patient has been evaluated for risks of suicidal ideation or behavior versus benefits of therapy
• According to the prescriber, the patient does not have moderately severe to severe depression
• According to the prescriber, within the past 5 years, the patient does not have a history of suicidal ideation or suicidal behavior
• Medication is prescribed by or in consultation with a rheumatologist

Reauthorization criteria

• Patient has been established on therapy for at least 6 months
• According to the prescriber, the patient has been evaluated for risks of suicidal ideation or behavior versus benefits of therapy
• According to the prescriber, the patient does not have moderately severe to severe depression
• According to the prescriber, the patient does not have suicidal ideation or suicidal behavior
• Patient meets at least ONE of the following: (a) Beneficial clinical response from baseline assessed by at least one objective measure such as ASDAS, ASQoL, BASDAI, BASFI, BAS-G, BASMI, DFI, HAQS, or serum markers (C-reactive protein, erythrocyte sedimentation rate); OR (b) Improvement in at least one symptom compared with baseline such as decreased pain, stiffness, or improved function or activities of daily living

Approval duration

initial 6 months, renewal 1 year