Skyrizi (risankizumab-rzaa) — United Healthcare
moderately to severely active Crohn’s disease
Initial criteria
- Diagnosis of moderately to severely active Crohn’s disease
- AND one of the following:
- A) Patient has been approved for loading dose of Skyrizi under active UnitedHealthcare medical benefit prior authorization for moderately to severely active Crohn’s disease
- OR B) Both of the following:
- i. Patient is currently on Skyrizi therapy for moderately to severely active Crohn’s disease 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 gastroenterologist
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