Medicare AdvantagePrior AuthLow impact
Skyrizi® (risankizumab-rzaa) (Revised)
Humana·Dermatology, Rheumatology, Gastroenterology·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 23, 2026
Summary
Humana updated its Skyrizi (risankizumab-rzaa) prior authorization policy effective July 22, 2026. The policy maintains existing coverage criteria for four indications: plaque psoriasis (age 6+, with prior conventional oral systemic therapy requirement), psoriatic arthritis (age 6+), Crohn's disease (age 18+), and ulcerative colitis (age 18+). All approvals are granted in plan year durations or through clinical review. This is a routine policy revision with no substantive coverage changes from the previous version.
Action Required
Before July 22, 2026: Verify in billing system that the Skyrizi prior authorization workflow reflects the updated policy revision date (7/22/2026). Confirm that prior authorization requirements remain unchanged for all four indications. No billing code changes are required. Billing team should ensure prior auth requests for Skyrizi include appropriate diagnosis verification (plaque psoriasis, psoriatic arthritis, Crohn's disease, or ulcerative colitis) and age confirmation (6+ for dermatologic/rheumatologic indications; 18+ for GI indications). For plaque psoriasis claims, ensure prior documentation of failed or contraindicated conventional oral systemic therapy. Claims submitted without proper prior authorization will be denied.