Medicare AdvantagePrior AuthHigh impact
Bimzelx (bimekizumab-bkzx) (Revised)
Humana·Dermatology, Rheumatology·Medicare Advantage
We identified it
Jul 1, 2026
Summary
This is a revised Prior Authorization policy for Bimzelx (bimekizumab-bkzx), a biologic medication, affecting Medicare Advantage members. The policy establishes new or updated prior authorization requirements for this drug. Specific clinical criteria, dosing, and authorization procedures have been revised and must be implemented immediately.
Action Required
Immediately: Billing and clinical staff must obtain prior authorization from Humana Medicare Advantage before dispensing or administering Bimzelx (bimekizumab-bkzx/J7231). Update billing system to flag this HCPCS code for mandatory prior auth requirement. Notify prescribers and pharmacy that all Bimzelx claims require pre-authorization or will be denied. Staff should reference the complete policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a610 for clinical authorization criteria. This is a revised policy—verify any previous Bimzelx authorization procedures are replaced with this new guidance.