Bimzelx (bimekizumab-bkzx) — United Healthcare

Hidradenitis Suppurativa (HS)

Preferred products

Diagnosis of moderate to severe hidradenitis suppurativa (Hurley Stage II or III)
AND One of the following:
(a) BOTH of the following:
History of failure to at least one oral antibiotic (e.g., doxycycline, clindamycin, rifampin) at maximally indicated doses, unless contraindicated or clinically significant adverse effects are experienced (document drug, date, and duration of trial)
AND History of failure, contraindication, or intolerance to BOTH of the following preferred products (document drug, date, and duration of trial):
• One of the preferred adalimumab products
• Cosentyx (secukinumab)
OR (b) BOTH of the following:
Patient is currently on Bimzelx therapy as documented by claims history or submission of medical records (document date and duration of therapy)
AND Patient has not received a manufacturer supplied sample at no cost in the prescriber’s office, or any form of assistance from a UCB sponsored program (e.g., sample card redeemed at a pharmacy for a free supply of medication) as a means to establish as a current user of Bimzelx
AND Patient is not receiving Bimzelx in combination with another targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Cosentyx (secukinumab), Enbrel (etanercept), Olumiant (baricitinib), Orencia (abatacept), Simponi (golimumab), Rinvoq (upadacitinib), Xeljanz (tofacitinib)]
AND Prescribed by or in consultation with a dermatologist

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

12 months