Subject: Specialty Quantity Limit Skyrizi 3049-H P2026a

Drug

SKYRIZI  (risankizumab-rzaa)

Policy:

Program Description

The standard limit is designed to allow a quantity sufficient for the most common uses of the medication. If the member’s plan allows a quantity limit exception review for the requested medication, coverage of an additional quantity may be provided up to the exception limit with prior authorization.

Covered Quantities

Coverage up to the exception limits may be provided with prior authorization via the Specialty Post Limit Quantity Exception Criteria for approval.

Medication	Standard Limit	Exception Limit
Skyrizi (risankizumab-rzaa) 55 mg/0.37 mL single-dose prefilled syringe	1 syringe per 84 days	2 syringes per 28 days
Skyrizi (risankizumab-rzaa) 90 mg/mL single-dose prefilled syringe	4 syringes per 56 days	Not applicable (N/A)
Skyrizi (risankizumab-rzaa) 150 mg/mL single-dose prefilled syringe/pen	1 syringe/pen per 84 days	2 syringes/pens per 28 days
Skyrizi (risankizumab-rzaa) 180 mg/1.2 mL single-dose prefilled syringe	1 syringe per 56 days	N/A
Skyrizi (risankizumab-rzaa) 180 mg/1.2 mL single-dose prefilled cartridge with on-body injector	1 cartridge per 56 days	N/A
Skyrizi (risankizumab-rzaa) 360 mg/2.4 mL single-dose prefilled cartridge with on-body injector	1 cartridge per 56 days	N/A
Skyrizi (risankizumab-rzaa) 600 mg/10 mL single-dose vial	6 vials per 56 days	N/A

FDA-recommended Dosing

Plaque Psoriasis and Psoriatic Arthritis

Pediatric Patients 6 Years of Age and Older

·        Less than 40 kg: 55 mg at weeks 0, 4, and every 12 weeks thereafter

·        40 kg or greater: 150 mg at weeks 0, 4, and every 12 weeks thereafter

Adults

150 mg at weeks 0, 4, and every 12 weeks thereafter

Crohn’s Disease and Ulcerative Colitis

Crohn’s Disease, Intravenous Induction

600 mg at weeks 0, 4, and 8

Ulcerative Colitis, Intravenous Induction

1200 mg at weeks 0, 4, and 8

Maintenance, Subcutaneous

180 mg or 360 mg at week 12, then every 8 weeks thereafter

Place of Service:

Outpatient

The above policy is based on the following references:

1.      Skyrizi [package insert]. North Chicago, IL: AbbVie Inc.; June 2026.

Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

August 16, 2026