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Risankizumab-rzaa (Skyrizi®)
BCBS Tennessee·Dermatology, Rheumatology, Gastroenterology·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
This is a NEW medical policy for Risankizumab-rzaa (Skyrizi®) establishing coverage criteria, prior authorization requirements, and documentation standards for four FDA-approved indications: plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. The policy requires specific prescriber specialties, TB screening documentation, and evidence of clinical response for continuation of therapy. Implementation is prohibited until December 1, 2026.
Action Required
Before December 1, 2026: Billing team must implement prior authorization workflow for Risankizumab-rzaa (Skyrizi®) claims. (1) Create prior auth requirement in billing system for all four indications (plaque psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis). (2) Update EMR/encounter templates to capture required documentation: for initial requests—affected body surface area (BSA), previous medications tried with response to therapy, or clinical reasons to avoid therapy; for continuation requests—evidence of positive clinical response or disease improvement. (3) Configure system to verify prescriber specialty matches indication (dermatologist for psoriasis, rheumatologist/dermatologist for PsA, gastroenterologist for CD/UC). (4) Add requirement to documentation checklist: TB infection evaluation prior to treatment initiation. (5) Implement billing rule preventing concurrent biologic/targeted synthetic drugs for same indication. (6) Alert providers and front desk staff: do not submit claims for Skyrizi® without completed prior authorization form showing medical necessity documentation. Failure to obtain prior authorization before service delivery will result in claim denials.