Bimzelx — Medica
Other inflammatory conditions covered under the standard Inflammatory Conditions – Bimzelx Prior Authorization Policy
Preferred products
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Otezla
- Skyrizi subcutaneous
- Sotyktu
- Stelara subcutaneous
- Taltz
- Tremfya subcutaneous
- Cosentyx subcutaneous
- Cimzia
- Rinvoq
- Xeljanz
- Xeljanz XR
Initial criteria
- Patient meets the standard Inflammatory Conditions – Bimzelx Prior Authorization Policy criteria; AND
- For Plaque Psoriasis: patient has tried ONE of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, Sotyktu, Stelara subcutaneous, Taltz, or Tremfya subcutaneous; OR
- For Psoriatic Arthritis: patient has tried ONE of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, Stelara subcutaneous, Taltz, or Tremfya subcutaneous; OR
- Patient has been established on Bimzelx for at least 90 days and prescription claims history indicates at least a 90-day supply of Bimzelx dispensed within the past 130 days (verification in prescription claims history or by prescriber required)
Approval duration
as directed or 1 year for a patient continuing therapy