Medicare AdvantagePrior AuthMedium impact
Skyrizi® (risankizumab-rzaa) (Revised)
Humana·Dermatology, Gastroenterology, Rheumatology·Medicare Advantage
Effective date
May 27, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Skyrizi (risankizumab-rzaa) prior authorization policy effective May 27, 2026. The policy maintains coverage for four indications (plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis) with specific clinical criteria requirements. Key change: Plaque psoriasis now requires documented prior therapy with or intolerance to a single conventional oral systemic treatment (e.g., methotrexate, cyclosporine), while psoriatic arthritis approval requires only diagnosis and age verification (no prior therapy requirement).
Action Required
By May 27, 2026: Billing and prior authorization teams must update internal policy workflows and system configurations to reflect the revised Skyrizi approval criteria. For plaque psoriasis claims: Ensure prior auth requests include documentation of prior conventional oral systemic therapy (methotrexate, cyclosporine, etc.) or documented contraindication/intolerance. For psoriatic arthritis claims: Update PA requirements to require only diagnosis confirmation and age verification (≥18 years) with no prior therapy requirement. For Crohn's disease and ulcerative colitis: Verify diagnosis of moderate-to-severe active disease and age ≥18 years. Update preauthorization system templates and provider education materials to reflect these differentiated requirements. Failure to properly document prior therapy for psoriasis indications may result in claim denials or PA request rejection.