Bimzelx (bimekizumab-bkzx) — United Healthcare
Psoriatic Arthritis (PsA)
Preferred products
- preferred adalimumab products
- Cimzia (certolizumab)
- Cosentyx (secukinumab)
- Enbrel (etanercept)
- Rinvoq (upadacitinib)
- Simponi (golimumab)
- Skyrizi (risankizumab)
- preferred ustekinumab products
- Tremfya (guselkumab)
- Xeljanz/Xeljanz XR (tofacitinib)
Initial criteria
- Diagnosis of active psoriatic arthritis
- AND one of the following: (a) History of failure to a 3-month trial of methotrexate at maximal dose unless contraindicated or clinically significant adverse effects OR (b) Previously treated with a targeted immunomodulator FDA-approved for PsA (document drug, date, and duration)
- AND one of the following: (a) History of failure, contraindication, or intolerance to two of the following preferred products: preferred adalimumab product, Cimzia, Cosentyx, Enbrel, Rinvoq, Simponi, Skyrizi, preferred ustekinumab product, Tremfya, or 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 or dermatologist
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