Subject: Specialty Quantity Limit Bimzelx 6221-H P2025

Drug

BIMZELX  (bimekizumab-bkzx)

Policy:

Program Description

The standard limit is designed to allow a quantity sufficient for the most common uses of the medication. If member’s plan allows a quantity limit exception review for the requested medication, coverage of an additional quantity may be provided up to the exception limit with prior authorization.

Covered Quantities

Coverage up to the exception limits may be provided with prior authorization via the Specialty Post Limit Quantity Exception Criteria for approval.

Medication	Standard Limit	Exception Limit
Bimzelx (bimekizumab-bkzx) 160 mg/mL   auto-injector/prefilled syringe	2 auto-injectors/syringes per 28 days	18 auto-injectors/syringes per 112 days
Bimzelx (bimekizumab-bkzx) 320 mg/2 mL   auto-injector/prefilled syringe	1 auto-injector/syringe per 28 days	9 auto-injectors/syringes per 112 days

FDA-recommended Dosing

Plaque psoriasis (PsO), with or without coexistent psoriatic arthritis, adults

Loading doses

320 mg at week 0, 4, 8, 12, and 16

Maintenance dose

320 mg every 8 weeks

For patients weighing greater than or equal to 120 kg, consider a dose of 320 mg every 4 weeks after week 16.

Psoriatic arthritis (PsA)/non-radiographic axial spondyloarthritis (nr-axSpA)/ ankylosing spondylitis (AS), adults

160 mg every 4 weeks

Hidradenitis Suppurativa (HS), adults

Loading doses

320 mg at week 0, 2, 4, 6, 8, 10, 12, 14, and 16

Maintenance dose

320 mg every 4 weeks

Place of Service:

Outpatient

The above policy is based on the following references:

1. Bimzelx [package insert]. Smyrna, GA: UCB, Inc.; November 2024.

Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

June 07, 2025