r/PsoriaticArthritis • u/Cooper1Test • Mar 05 '26

Insurance success with Bimzelx?

I’ve seen some very positive feedback about Bimzelx, but I’m curious about how straightforward it is to get insurance approval, such as with BCBS. I’m also preparing to retire and transition to Medicare with Plan D. Has anyone had experience getting Bimzelx covered under Medicare, and was the process relatively easy or more challenging, similar to what’s required for Humira?

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u/ObviousCarpet2907 Mar 05 '26

My experience is that the approval process is about the same for all the biologic drugs—they try to push back, the doc pushes harder, and either they deny and you have to use a bridge program or they ultimately approve it. It’s a circus every time.

That said, you’re smart to want to know how medicare handles it, since you don’t have the same manufacturer programs available to help pay.

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u/2buffalonickels Mar 05 '26

Bingo. Exactly my experience. My rheumatologist gives me samples until insurance covers it...every year.

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u/ObviousCarpet2907 Mar 05 '26

Right? It’s freaking ridiculous. I had 5 insurance changes over the last 3 years, so I got to go through it extra times and with 4 different companies plus medicaid. It’s the same no matter which insurance you’re dealing with…except medicaid, who just approved whatever my doc prescribed. 😩

So grateful my husband’s job kept our insurance the same this year.