Kaiser Foundation Health Plan Southern California - All plan years
Skyrizi (Syrg) (risankizumab-rzaa)
Drugs for the Skin : Drugs for the Skin
  • PA_APPLIES
  • Available through Specialty Pharmacy;
  • Chorea in Huntington's Disease:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Tardive Dyskinesia (TD):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    AIMS Score: N/A
    Patient Must Not Have Congenital LQTS or Arrhythmias Associated with Prolonged QT Interval: No
    Patient Must Not Have Risk of Suicidal Behavior and Unstable Psychiatric Symptoms: No
    Concomitant Use With Other VMAT inhibitors Prohibited: No
    Supporting Documentation Requirements: 1 of Lab Tests;Medication History

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