Bimzelx (bimekizumab-bkzx) — United Healthcare

Plaque Psoriasis (PsO)

Preferred products

Diagnosis of moderate to severe plaque psoriasis
AND one of the following:
(a) All of the following: i. ≥3% body surface area involvement OR palmoplantar/facial/genital involvement OR severe scalp psoriasis AND ii. History of failure to one topical therapy unless contraindicated or clinically significant adverse effects (document drug, date, and duration of trial): corticosteroids, vitamin D analogs, tazarotene, calcineurin inhibitors, anthralin, or coal tar AND iii. History of failure to a 3-month trial of methotrexate at maximum indicated dose unless contraindicated or clinically significant adverse effects
OR (b) Patient previously treated with a targeted immunomodulator FDA-approved for plaque psoriasis (document drug, date, and duration of therapy)
AND one of the following: (a) History of failure, contraindication, or intolerance to two of: preferred adalimumab product, Cimzia, Cosentyx, Enbrel, Skyrizi, Sotyktu, preferred ustekinumab product, or Tremfya OR (b) Both: (i) Currently on Bimzelx therapy as documented AND (ii) Has not received manufacturer sample or UCB assistance to establish current use
AND Patient not receiving Bimzelx in combination with another targeted immunomodulator (list provided)
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 (list provided)

12 months