Anthem Blue Cross (HMO, PPO, EPO)
Skyrizi 75 Mg/0.83 Ml Syrg (risankizumab-rzaa)
Drugs for the Skin : Drugs for the Skin
  • Prior Authorization: Psoriasis (PsO):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Psoriatic Arthritis (PsA):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)

  • Psoriasis (PsO):
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    TB Test required: Yes
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: 3
    Overall % of Body Surface For Initiation With Sensitive Areas: Unspecified
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: Yes

    Psoriatic Arthritis (PsA):
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: Yes

  • Step Therapy: ST Single Generic

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