Bimzelx (bimekizumab-bkzx) — United Healthcare
Ankylosing Spondylitis (AS)
Preferred products
- preferred adalimumab products
- Cimzia (certolizumab)
- Cosentyx (secukinumab)
- Enbrel (etanercept)
- Rinvoq (upadacitinib)
- Simponi (golimumab)
- Xeljanz/Xeljanz XR (tofacitinib)
Initial criteria
- Diagnosis of active ankylosing spondylitis
- AND one of the following: (a) History of failure to two NSAIDs at maximally indicated doses, each used ≥4 weeks unless contraindicated or intolerant (document drug, date, and duration) OR (b) Previously treated with a targeted immunomodulator FDA-approved for AS (document drug, date, and duration)
- AND one of the following: (a) History of failure, contraindication, or intolerance to two of: preferred adalimumab product, Cimzia, Cosentyx, Enbrel, Rinvoq, Simponi, Xeljanz OR (b) Both: (i) Currently on Bimzelx therapy (documented) AND (ii) Has not received manufacturer sample/UCB program assistance to establish current use
- AND Patient is not receiving Bimzelx in combination with another targeted immunomodulator (list provided)
- AND Prescribed by or in consultation with a rheumatologist
Reauthorization criteria
- Documentation of positive clinical response to Bimzelx therapy
- AND patient is not receiving Bimzelx in combination with another targeted immunomodulator (list provided)
Approval duration
12 months