Skyrizi (risankizumab-rzaa) — United Healthcare
active psoriatic arthritis
Initial criteria
- Diagnosis of active psoriatic arthritis
- AND one of the following:
- A) History of failure to a 3-month trial of methotrexate at maximally indicated dose, unless contraindicated or clinically significant adverse effects
- OR B) Patient has been previously treated with a targeted immunomodulator FDA-approved for psoriatic arthritis (e.g., adalimumab, Cimzia, Cosentyx, Enbrel, Otezla, Rinvoq, Simponi, Tremfya, Xeljanz/Xeljanz XR, ustekinumab)
- OR C) Both of the following:
- i. Patient is currently on Skyrizi therapy as documented by claims history or medical records
- AND ii. Patient has not received a manufacturer supplied sample or any form of assistance from the Abbvie Skyrizi Complete program
- AND Patient is not receiving Skyrizi in combination with another targeted immunomodulator [list as in policy]
- AND Prescribed by or in consultation with a rheumatologist or dermatologist
Reauthorization criteria
- Documentation of positive clinical response to Skyrizi therapy
- AND Patient is not receiving Skyrizi in combination with another targeted immunomodulator [list as in policy]
Approval duration
12 months