Skyrizi (risankizumab-rzaa, AbbVie) is an interleukin-23 (IL-23) inhibitor approved for four immune-mediated inflammatory conditions in adults: moderate-to-severe plaque psoriasis, active psoriatic arthritis, moderately-to-severely active Crohn's disease, and moderately-to-severely active ulcerative colitis. It has become one of the most prescribed biologics in immunology, but access depends heavily on the patient's indication, insurance type, and whether prior authorization criteria are met.
This guide is for access teams, prior authorization coordinators, and prescribers who need to navigate coverage for Skyrizi across payer types.
Short answer
| Skyrizi (risankizumab-rzaa) | |
|---|---|
| Drug class | IL-23 inhibitor (p19 subunit) |
| Manufacturer | AbbVie Inc. |
| FDA indications | Plaque psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis |
| Administration | Subcutaneous injection (PsO/PsA: 150 mg every 12 wk; CD/UC: 180 or 360 mg every 8 wk after IV induction) |
| List price (WAC) | ~$23,838 per dose; annual cost $70,000–$90,000+ |
| Commercial copay | $0 per dose with Skyrizi Complete Savings Card |
| Medicare Part D | Covered; $0–$2,100/year depending on coverage phase |
| Medicaid | $8/month or less depending on state |
| PA required | Yes, for all payer types and indications |
| Step therapy | Commonly required (topical therapy failure for PsO; TNF inhibitor or other biologic failure may be required by some plans) |
FDA-approved indications and dosing
Plaque psoriasis (approved April 2019)
- Indicated for adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy
- Dosing: 150 mg subcutaneous injection at weeks 0 and 4, then every 12 weeks
- Pivotal trials: ULTIMMA-1, ULTIMMA-2, IMMHANCE, IMMVENT
Psoriatic arthritis (approved January 2022)
- Indicated for adults with active psoriatic arthritis
- Dosing: 150 mg subcutaneous injection at weeks 0 and 4, then every 12 weeks
- Can be used alone or in combination with disease-modifying antirheumatic drugs (DMARDs)
Crohn's disease (approved June 2022)
- Indicated for adults with moderately-to-severely active Crohn's disease
- Induction: 600 mg IV infusion over at least 1 hour at weeks 0, 4, and 8
- Maintenance: 180 mg or 360 mg subcutaneous injection at week 12, then every 8 weeks
- AbbVie submitted an FDA application in April 2026 for subcutaneous induction (eliminating the need for IV infusions)
Ulcerative colitis (approved June 2024)
- Indicated for adults with moderately-to-severely active ulcerative colitis
- Induction: 1,200 mg IV infusion over at least 2 hours at weeks 0, 4, and 8
- Maintenance: 180 mg or 360 mg subcutaneous injection at week 12, then every 8 weeks
Coverage by payer type
Commercial insurance
Skyrizi is covered by most major commercial plans as a specialty-tier medication (Tier 4 or 5). Prior authorization is universally required.
| Payer | Coverage status | Key requirements |
|---|---|---|
| Aetna (CVS Health) | Covered; specialty tier | PA required; clinical documentation of severity (PASI ≥10, BSA ≥10%, or PGA ≥3 for PsO); may require TNF inhibitor failure |
| Blue Cross Blue Shield | Covered; varies by plan | PA required; diagnosis-specific criteria; step therapy common |
| Cigna | Covered; specialty tier | PA required; may require documented failure of prior systemic therapy |
| UnitedHealthcare | Covered; specialty tier | PA required; step therapy may apply; quantity limits |
| OptumRx formulary | Tier 3 (preferred specialty) | PA required; quantity limits |
Typical PA criteria for plaque psoriasis:
- Diagnosis of moderate-to-severe plaque psoriasis
- BSA ≥3% affected or crucial body areas affected (hands, feet, face, scalp, genitals)
- Failure, contraindication, or intolerance to at least one topical therapy (corticosteroids, vitamin D analogs, tazarotene, calcineurin inhibitors) after a minimum 4-week trial
- For some plans: failure of prior systemic therapy or phototherapy
- TB screening completed prior to initiation
Typical PA criteria for Crohn's disease or ulcerative colitis:
- Confirmed diagnosis of moderately-to-severely active CD or UC
- Failure, contraindication, or intolerance to conventional therapies (aminosalicylates, corticosteroids, immunomodulators)
- Some plans require prior biologic failure (TNF inhibitor or vedolizumab)
- TB screening and hepatitis B screening completed
Medicare Part D
Skyrizi is covered under Medicare Part D. The IRA out-of-pocket cap is $2,100 for 2026. With the Skyrizi Complete Savings Card not available for government-insured patients, Medicare beneficiaries should check their specific Part D plan formulary.
Key 2026 Medicare changes:
- $2,100 annual out-of-pocket cap for all Part D drugs
- Medicare Prescription Payment Plan (MPPP) allows monthly installment payments instead of lump-sum cost-sharing
- Low-Income Subsidy (LIS) patients pay $12.65 or less per treatment
Medicaid
Skyrizi is covered by state Medicaid programs with prior authorization. Cost is typically $8/month or less depending on the state plan. PA criteria mirror commercial requirements with possible additional state-specific documentation.
Prior authorization process
Required documentation
| Indication | Required documentation |
|---|---|
| Plaque psoriasis | BSA measurement, PGA or PASI score, prior topical therapy records, TB screening |
| Psoriatic arthritis | Joint examination findings, imaging if available, prior DMARD therapy records, TB screening |
| Crohn's disease | Endoscopy or imaging confirmation, prior conventional therapy records, liver enzyme monitoring plan, TB screening |
| Ulcerative colitis | Endoscopy confirmation, prior conventional therapy records, liver enzyme monitoring plan, TB screening |
Reauthorization requirements
- PsO/PsA: Documentation of maintained or improved clinical response (reduced BSA, improved signs/symptoms)
- CD/UC: Documentation of clinical response or remission; maintenance of liver enzyme monitoring for CD
- Authorization duration: Typically 6–18 months depending on payer and indication
Common denial reasons and solutions
| Denial reason | Solution | Required documentation |
|---|---|---|
| Not medically necessary | Submit severity documentation | PASI ≥10, BSA ≥10%, or PGA ≥3; endoscopy for CD/UC |
| Step therapy not met | Document prior therapy failure | Detailed records of prior systemic or biologic therapy |
| Incomplete TB screening | Submit complete screening results | TST/IGRA results + chest X-ray if indicated |
| Non-formulary drug | Request formulary exception | Medical necessity letter + documentation of alternatives tried |
| Quantity limits exceeded | Provide FDA dosing rationale | Prescriber attestation of appropriate dosing per label |
Cost and patient assistance
Manufacturer savings programs
| Program | Eligibility | Benefit |
|---|---|---|
| Skyrizi Complete Savings Card | Commercially insured patients | $0 per dose (card covers copay) |
| Bridge Program | Commercially insured ≤63 years old with PA denial and confirmed appeal | Free Skyrizi for up to 2 years or until insurance approval |
| myAbbVie Assist | Uninsured or underinsured patients who cannot afford medication | Free medication for eligible patients |
Patient Access Network (PAN) Foundation
The PAN Foundation provides copay assistance for Medicare patients who meet income eligibility criteria. This can significantly reduce out-of-pocket costs for Skyrizi under Part D.
Cost by insurance type
| Insurance type | Approximate out-of-pocket cost |
|---|---|
| Commercial + Skyrizi Complete Savings Card | $0 per dose |
| Commercial without savings card | Varies by plan (specialty copay or coinsurance) |
| Medicare Part D | $0–$2,100/year depending on coverage phase |
| Medicare Part D + LIS | $12.65 or less per treatment |
| Medicaid | $8/month or less depending on state |
| Uninsured | Full WAC (~$23,838/dose) or free via myAbbVie Assist if eligible |
What changed in 2026
- Subcutaneous induction submission (April 2026): AbbVie submitted an FDA application for subcutaneous induction dosing for Crohn's disease, which would eliminate the need for IV infusions in a clinical setting. If approved, this could change site-of-care requirements and billing pathways.
- Medicare Part D $2,100 out-of-pocket cap: Effective January 2026 under the IRA, capping annual Part D out-of-pocket costs.
- Medicare Prescription Payment Plan (MPPP): Allows patients to spread out-of-pocket costs across monthly payments rather than paying lump sums at the pharmacy.
- Skyrizi maintains #1 first-line biologic position: Per AbbVie internal analytics, Skyrizi remains the most commonly prescribed first-line biologic by both dermatologists and rheumatologists for psoriatic arthritis.
- Expanded payer coverage for UC: Since the UC approval in June 2024, most major commercial payers have added Skyrizi to their formularies for this indication with PA criteria.
What to monitor
- FDA decision on subcutaneous induction for CD: If approved, this changes the access pathway for Crohn's disease patients by removing the infusion center requirement.
- Payer formulary changes: Monitor for any shifts in preferred IL-23 inhibitor status during 2026 formulary updates.
- Biosimilar competition for Humira: As Humira biosimilar adoption continues, some payers may adjust step therapy requirements that previously required TNF inhibitor failure before allowing IL-23 inhibitors.
- New IL-23 competitors: Monitor any new IL-23 inhibitor approvals that could affect formulary positioning.
- IRA expanded negotiation: Monitor whether Skyrizi or other immunology biologics are selected for future Medicare price negotiation rounds.
Sources
- FDA, Skyrizi prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215875slbl.pdf
- Drugs.com, Skyrizi FDA approval history: https://www.drugs.com/history/skyrizi.html
- AbbVie, Skyrizi HCP coverage and access: https://www.skyrizihcp.com/dermatology/coverage-access
- AbbVie, Skyrizi cost and savings for Crohn's disease: https://www.skyrizi.com/crohns/cost-and-savings
- AbbVie, Skyrizi cost and savings for ulcerative colitis: https://www.skyrizi.com/ulcerative-colitis/cost-and-savings
- Mass General Brigham Health Plan, Skyrizi PA criteria (effective May 2026): https://resources.massgeneralbrighamhealthplan.org/pharmacy/PharmacyPolicies/CommercialPolicies/Skyrizi_PA_ComExch_Rx_05.01.2026.pdf
- Aetna, Risankizumab-rzaa clinical policy bulletin: https://www.aetna.com/cpb/medical/data/1000_1099/1009.html
- FEHB, Skyrizi pharmacy policy (effective January 2026): https://www.fepblue.org/-/media/PDFs/Medical-Policies/2026/January/Pharmacy-Policies/Remove-and-Replace/590038-Skyrizi-risankizumabrzaa.pdf
- AbbVie, FDA submission for subcutaneous induction in Crohn's disease (April 2026): https://news.abbvie.com/2026-04-27-AbbVie-Submits-Regulatory-Application-to-FDA-for-SKYRIZI-R-risankizumab-rzaa-Subcutaneous-Induction-for-Adults-with-Moderately-to-Severely-Active-Crohns-Disease
