Bimzelx — Medica
Psoriatic Arthritis
Preferred products
- Ankylosing Spondylitis: Enbrel, adalimumab-adbm, adalimumab-adaz, adalimumab-ryvk, Simlandi, Taltz
- Hidradenitis Suppurativa: adalimumab-adbm, adalimumab-adaz, adalimumab-ryvk, Simlandi, Cosentyx subcutaneous
- nr-axSpA: Cimzia, Taltz
- Plaque Psoriasis: Enbrel, adalimumab-adbm, adalimumab-adaz, adalimumab-ryvk, Simlandi, Otezla, Skyrizi subcutaneous (pen or syringe), Sotyktu, Imuldosa subcutaneous, Selarsdi subcutaneous, ustekinumab-ttwe subcutaneous, Yesintek subcutaneous, Taltz, Tremfya subcutaneous
- Psoriatic Arthritis: Enbrel, adalimumab-adbm, adalimumab-adaz, adalimumab-ryvk, Simlandi, Otezla, Skyrizi subcutaneous (pen or syringe), Imuldosa subcutaneous, Selarsdi subcutaneous, ustekinumab-ttwe subcutaneous, Yesintek subcutaneous, Taltz, Tremfya subcutaneous
Initial criteria
- Patient meets the standard Inflammatory Conditions – Bimzelx Prior Authorization Policy criteria
- Patient meets ONE of the following:
- a) Ankylosing Spondylitis – tried one of Enbrel, an adalimumab product, or Taltz (Cimzia, infliximab products, or Simponi also count)
- b) Hidradenitis Suppurativa – tried one of an adalimumab product or Cosentyx subcutaneous
- c) nr-axSpA – tried one of Cimzia or Taltz (Enbrel, adalimumab products, infliximab products, or Simponi also count)
- d) Plaque Psoriasis – tried one of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, Sotyktu, an ustekinumab subcutaneous product, Taltz, or Tremfya subcutaneous
- e) Psoriatic Arthritis – tried one of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, an ustekinumab subcutaneous product, Taltz, Tremfya subcutaneous, Cimzia, infliximab products, or Simponi
- f) Patient has been established on Bimzelx for at least 90 days with verification of prescription claims showing a 90-day supply within the past 130 days, or if claims not available, verified by prescriber
Approval duration
1 year