Does Medicare Part D cover Bimzelx?
Bimzelx appears on the Medicare Part D formularies of 47 payers in the corpus, across 1,450 plans. 46 payers require prior authorization on every covering plan, 1 on some plans, and 0 on none.
Beyond prior authorization: 0 covering plans require step therapy (another drug tried first) and 1,321 apply a quantity limit, on at least one Bimzelx product.
Prior authorization is set per plan, not per payer. Pick a payer below for its full plan-by-plan breakdown, effective 2026-06-30.
Coverage by payer
| Payer | Plans covering | Require prior auth | Step therapy | Quantity limit | Status |
|---|---|---|---|---|---|
| Aetna (CVS Health) | 643 | 643 | 0 | 643 | Prior authorization required |
| Devoted Health | 415 | 415 | 0 | 415 | Prior authorization required |
| Kaiser Permanente | 115 | 16 | 0 | 0 | Varies by plan |
| Molina Healthcare | 51 | 51 | 0 | 51 | Prior authorization required |
| Zing Health Of Michigan, INC. | 33 | 33 | 0 | 33 | Prior authorization required |
| Blue Cross Blue Shield (affiliate) | 16 | 16 | 0 | 16 | Prior authorization required |
| Central Health Plan Of California, INC. | 15 | 15 | 0 | 15 | Prior authorization required |
| Clover Health | 13 | 13 | 0 | 13 | Prior authorization required |
| Mount Carmel Health Plan, INC. | 11 | 11 | 0 | 11 | Prior authorization required |
| Allina Health And Aetna Insurance Company | 9 | 9 | 0 | 9 | Prior authorization required |
| Mvp Health Plan, INC. | 8 | 8 | 0 | 8 | Prior authorization required |
| Fallon Community Health Plan | 8 | 8 | 0 | 8 | Prior authorization required |
| Health Partners Plans, INC. | 8 | 8 | 0 | 0 | Prior authorization required |
| Viva Health, INC. | 7 | 7 | 0 | 7 | Prior authorization required |
| Martin'S Point Generations Advantage, INC. | 7 | 7 | 0 | 7 | Prior authorization required |
| Christus Health Plan | 6 | 6 | 0 | 6 | Prior authorization required |
| Elderplan, INC. | 6 | 6 | 0 | 6 | Prior authorization required |
| Connecticare, INC. | 6 | 6 | 0 | 6 | Prior authorization required |
| Hopkins Health Advantage, INC. | 5 | 5 | 0 | 5 | Prior authorization required |
| Usable Mutual Insurance Company | 5 | 5 | 0 | 5 | Prior authorization required |
| Hpmp Of Florida, INC. | 5 | 5 | 0 | 5 | Prior authorization required |
| Hawaii Medical Service Association | 4 | 4 | 0 | 4 | Prior authorization required |
| Sharp Health Plan | 4 | 4 | 0 | 4 | Prior authorization required |
| Clever Care Of Golden State, INC. | 4 | 4 | 0 | 4 | Prior authorization required |
| Metroplus Health Plan, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Partners Insurance Company INC | 3 | 3 | 0 | 0 | Prior authorization required |
| Mount Carmel Health Insurance Company | 3 | 3 | 0 | 3 | Prior authorization required |
| Senior Whole Health, LLC | 3 | 3 | 0 | 3 | Prior authorization required |
| Paramount Care, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Mount Carmel Health Plan Of Idaho, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Mercy Care | 3 | 3 | 0 | 3 | Prior authorization required |
| Usable HMO, INC. | 3 | 3 | 0 | 3 | Prior authorization required |
| Commonwealth Care Alliance, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Neighborhood Health Plan Of Rhode Island | 2 | 2 | 0 | 2 | Prior authorization required |
| Partners Insurance Company Of New Jersey INC | 2 | 2 | 0 | 0 | Prior authorization required |
| Senior Whole Health Of New York, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Trinity Health Plan Of Michigan INC | 2 | 2 | 0 | 2 | Prior authorization required |
| Mount Carmel Health Plan Of New York, INC. | 2 | 2 | 0 | 2 | Prior authorization required |
| Elevance Health (Anthem) | 2 | 2 | 0 | 2 | Prior authorization required |
| Johns Hopkins Health Plan Of Virginia, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Itasca Medical Care | 1 | 1 | 0 | 1 | Prior authorization required |
| Connecticare Insurance Company, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Paramount Insurance Company | 1 | 1 | 0 | 1 | Prior authorization required |
| Orange County Health Authority | 1 | 1 | 0 | 0 | Prior authorization required |
| Health Choice Arizona, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
| Hawaii Medical Service Association (Hmsa) | 1 | 1 | 0 | 1 | Prior authorization required |
| Healthfirst Insurance Company, INC. | 1 | 1 | 0 | 1 | Prior authorization required |
“Require prior auth”, “step therapy” and “quantity limit” each count a plan when any Bimzelx product on its formulary carries that condition.
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.