Bimzelx — Cigna
nonradiographic axial spondyloarthritis
Preferred products
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- Simlandi (adalimumab-ryvk)
- Taltz
- Otezla
- Skyrizi SC
- Ustekinumab SC Products (Stelara SC, Imuldosa SC, Selarsdi SC, ustekinumab-ttwe SC, Yesintek SC)
- Tremfya SC
Initial criteria
- Patient must meet the respective standard Prior Authorization Policy criteria for the requested inflammatory condition AND
- Patient must have tried the Preferred Product(s) according to step level when clinically appropriate prior to approval of a Non-Preferred Product AND
- Step 1 (Preferred Products): Enbrel, adalimumab products (Cyltezo/adalimumab-adbm, adalimumab-adaz, Simlandi/adalimumab-ryvk) ± Taltz, Otezla, Skyrizi SC, Ustekinumab SC Products (Stelara SC, Imuldosa SC, Selarsdi SC, ustekinumab-ttwe SC, Yesintek SC) ± Tremfya SC depending on indication
- Step 2a (Non-Preferred directed to one Step 1 Product): Tocilizumab SC Products (Actemra SC, Tyenne SC) or Rinvoq (tablets, LQ) or Xeljanz (tablets, XR tablets, oral solution) depending on indication
- Step 2b (Non-Preferred directed to one Step 1 Product): Bimzelx if applicable
- Step 3a (Non-Preferred directed to two Step 1 or Step 2a Products with documentation required): Cimzia, Kevzara, Kineret, Olumiant, Orencia SC, Simponi SC, Cosentyx SC
- Prescriber must provide written documentation supporting trials of required Preferred Products [documentation required] which may include chart notes, prescription claims, or receipts
Reauthorization criteria
- Continuation of therapy with a Non-Preferred Product must be supported with verification in prescription claims history showing that the patient has received the product for 90 or 120 days within a 130-day look‑back period OR prescriber verification that the patient has been receiving the product for that period via paid claims (no samples/coupons)
- Other continuation conditions may apply as specified in the step criteria
Approval duration
1 year