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Bimzelx (bimekizumab-bkzx)United Healthcare

active ankylosing spondylitis

Initial criteria

  • Diagnosis of active ankylosing spondylitis
  • Patient is not receiving Bimzelx in combination with another targeted immunomodulator [e.g., Enbrel (etanercept), Simponi (golimumab), Orencia (abatacept), adalimumab, Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib)]

Reauthorization criteria

  • Documentation of positive clinical response to Bimzelx therapy
  • Patient is not receiving Bimzelx in combination with another targeted immunomodulator [e.g., Enbrel (etanercept), Simponi (golimumab), Orencia (abatacept), adalimumab, Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib)]

Approval duration

12 months