Your doctor prescribed Skyrizi because it’s the right treatment for your condition. Your insurer denied it. And in a growing number of cases, the reason has little to do with whether you actually need the drug. It has to do with money: a cheaper, older competitor recently became available, and some insurers would rather you take that one.

Skyrizi (risankizumab) is a targeted biologic. It blocks a specific protein, called IL-23, that drives inflammation in autoimmune disease. That targeting is what sets it apart from an older drug, Stelara, which blocks IL-23 along with a second protein, IL-12. Because Skyrizi leaves IL-12 alone, it works more narrowly. In studies that compared the two head-to-head for psoriasis, Skyrizi cleared skin better, and it carries no boxed warning (the FDA’s most serious safety label). It’s approved for four conditions across two specialties: plaque psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis.

None of that stopped insurers from putting it behind some of the toughest coverage barriers in specialty pharmacy. Stelara now comes in cheaper “biosimilar” versions (near-identical copies that arrive once a brand-name drug loses patent protection), and because they treat the same conditions, some plans would rather you take the older, less targeted drug than the one your doctor chose. Some plans have dropped Skyrizi from their covered drug list entirely, or placed it somewhere that makes it harder to get. Others will only consider it after you’ve tried and failed other drugs first, like a TNF blocker or a version of ustekinumab.

Here’s the part insurers count on you not knowing: these denials can be overturned. Fewer than 1% of denied claims are ever appealed, which is exactly how the system is designed to work. We see this every day at Claimable, where our appeals succeed more than 80% of the time in established conditions.

Skyrizi denials aren’t all the same. What you’re up against depends on your diagnosis, how you take the drug, and the specific barrier your plan put up. A psoriasis patient whose plan prefers Stelara is in a different fight than a Crohn’s patient denied at the infusion stage. This guide walks through each kind and what to do about it.

Why Insurance Companies Deny Skyrizi

The reason on your denial letter shapes everything about how you respond. It tells you what to gather, which argument to lead with, and whether a quick fix might solve it before you even need a formal appeal.

Why Skyrizi denials come in different forms

Skyrizi treats four conditions, and how you take it depends on which one you have.

For psoriasis and psoriatic arthritis, it’s an injection under the skin. You get two starter doses four weeks apart, then one every 12 weeks after that.

For Crohn’s disease and ulcerative colitis, you start differently. The first three doses are IV infusions, given at weeks 0, 4, and 8, to get the drug working. After that, you switch to an injection under the skin every 8 weeks, starting at week 12.

That split matters for one reason: the infusions and the injections are paid for by two different parts of your insurance. The infusions usually go through your medical benefit (the part that covers doctor visits and procedures), and the injections go through your pharmacy benefit (the part that covers prescriptions). So you can end up needing two separate approvals, and a denial at either stage can come down to a billing mix-up rather than whether you truly need the drug. It’s the same headache Entyvio patients run into.

There’s no generic or biosimilar version of Skyrizi. AbbVie is the only maker, and that isn’t expected to change soon. At roughly $23,800 per dose, it’s one of the most expensive specialty drugs on the market, which is why every major insurer scrutinizes it so hard.

The bigger pressure right now comes from competition. Stelara’s cheaper biosimilar copies give insurers a lower-cost option for the same conditions, and that price difference is driving a growing share of Skyrizi denials.

What we see across thousands of appeals

Denial letters are written to end the conversation. Here are the most common types, what they really mean, and your best first move.

“You have to try other drugs first” (step therapy)

Most insurers want you to have failed at least one TNF blocker before they’ll cover Skyrizi, no matter which condition you have. Some go further and require two failed biologics, or a trial of a ustekinumab product specifically. What counts varies by diagnosis:

Here’s the detail that changes outcomes: “failure” doesn’t only mean you tried a drug and it didn’t work. It also covers side effects, and it covers drugs your doctor has already ruled out as unsafe for you. If a required drug carries a real risk in your case, that counts as a failure even if you never took a single dose.

The argument that tends to win: the major dermatology guidelines (AAD/NPF) back IL-23 blockers like Skyrizi for moderate-to-severe psoriasis, and the 2025 gastroenterology guidelines (ACG) go a step further for Crohn’s. They specifically recommend risankizumab over ustekinumab for patients who’ve already been on a TNF blocker. Pointing to guidelines like these shows your doctor’s choice lines up with what the specialists recommend. When the insurer’s requirements demand more than the guidelines do, that gap is the heart of your appeal.

“Try a biosimilar instead”

This denial is a direct result of those cheaper ustekinumab copies hitting the market. Because they cost the insurer less, some plans want you to try one - often Stelara - before they’ll approve Skyrizi, even though the two drugs aren’t the same.

Why that matters: Skyrizi and Stelara are not interchangeable. They work on different targets. Skyrizi blocks only IL-23, while Stelara blocks both IL-23 and IL-12. That difference, plus the head-to-head psoriasis data where Skyrizi came out ahead, makes it a genuinely different drug, not a brand-name stand-in for a cheaper copy.

The argument that wins depends on your history. If you’ve already tried a ustekinumab product and it didn’t work well enough, your appeal can point to that. If you haven’t tried it, but your doctor chose Skyrizi for specific clinical reasons (its more targeted action, the stronger data, something about your particular disease), that reasoning needs to be spelled out in your letter of medical necessity. The insurer is treating the two drugs as the same because they’re both in the IL-23 family. Your appeal’s job is to show they aren’t.

“Not medically necessary”

This one usually means the original request was too thin. A stronger resubmission should include your diagnosis with its billing codes, your disease severity backed by objective measures (PASI and BSA for psoriasis, joint counts for psoriatic arthritis, CDAI for Crohn’s, partial Mayo for ulcerative colitis), a full list of what you’ve tried before with dates and why each was stopped, and your doctor’s reasoning for choosing Skyrizi. If the first request went in bare, a thorough resubmission often clears it up without a formal appeal.

“Not on the covered drug list” (formulary exclusion)

If your plan doesn’t cover Skyrizi at all, your main path is a formulary exception with medical necessity documentation. Which drugs a plan covers changes by plan and by year, so check your plan’s current drug list before you build your case.

Then document why the alternatives the plan does cover (TNF blockers, a ustekinumab copy, other IL-23 or IL-17 drugs) aren’t right for you, either because you’ve already tried and failed them or because something about your situation makes Skyrizi the better choice.

“Infusion denied” (Crohn’s and ulcerative colitis)

Crohn’s patients start Skyrizi with three IV infusions of 600 mg, at weeks 0, 4, and 8. Ulcerative colitis patients get the same three-infusion schedule at a higher dose, 1,200 mg. These infusions go through your medical benefit. The at-home injections that follow go through your pharmacy benefit.

Denials at the infusion stage usually trace back to paperwork: the request went through the wrong benefit, or the billing codes were wrong. Before you build a formal appeal, confirm the infusion request was filed under the medical benefit with the right codes.

“You have to use our pharmacy”

Skyrizi is only dispensed through specialty pharmacies. If your plan requires a specific one and you tried to fill it somewhere else, this denial has nothing to do with whether you should be on the drug. Find out which pharmacy your plan wants and have your doctor send the prescription there.

How to Appeal a Skyrizi Denial, Step by Step

Step 0: Rule out a paperwork problem first. Before you build a full appeal, check for a simple error. A lot of Skyrizi denials come down to wrong billing codes, or a request sent through the wrong part of your insurance. For Crohn’s and ulcerative colitis especially, make sure the infusions were billed to your medical benefit and the injections to your pharmacy benefit. Fixing a coding mistake and resubmitting can clear the denial without a full appeal.

Step 1: Find your deadline. Most commercial plans give you 180 days. UnitedHealthcare limits many plans to 65 days. Medicare Advantage plans give you 60. Miss the deadline and you lose the right to appeal, so this is the first thing to pin down.

Step 2: Use both tracks. Your doctor can file a clinical appeal (resubmitting the request, writing a letter of medical necessity, asking for a doctor-to-doctor review). You can file your own appeal separately. These run in parallel and strengthen each other, and your own appeal comes with guaranteed response times and the right to an outside review. File both.

Step 3: Check your paperwork. Confirm your billing codes, your severity scores, and your treatment history (with dates, doses, and why each earlier drug was stopped). For Crohn’s and ulcerative colitis, double-check that the infusions were filed under the medical benefit.

Step 4: Get a letter of medical necessity. This is one of the most important documents in your appeal. It should cover your diagnosis, your severity scores, your full treatment history, and your doctor’s reasons for choosing Skyrizi, written to answer the insurer’s specific denial reason. You can ask your doctor directly: “I need a letter of medical necessity for my Skyrizi appeal. Can you include my diagnosis, my severity scores, my treatment history, and why you chose Skyrizi over the drugs the insurer is asking me to try?”

Step 5: Build the package. A complete appeal has a cover letter, the letter of medical necessity, your supporting medical records, and your personal statement. Build it around three things: your story (how your condition affects your daily life and what getting the right treatment would change), the clinical evidence (the guidelines that back your treatment), and the policy and legal side (how your case meets the plan’s own rules, plus your protections under the ACA and any state step therapy laws).

Step 6: Submit and track. Send it the way your denial letter tells you to. Insurers have to respond within 30 days for a standard appeal, or 72 hours if it’s urgent. Keep a copy of everything.

Step 7: Escalate if you’re denied again. You have the right to an outside review by an independent third party, and in most states their decision is binding. You can also file a complaint with your state insurance department, and depending on your plan, you may have further options under federal law or your state’s step therapy laws.

An Easier Way: Let Claimable Handle Your Skyrizi Appeal

If all of this is more than you can take on, or you’ve already been denied once and want a stronger approach, Claimable can take it from here.

Here’s how it works. You answer a few questions about your denial and your medical history. We build a custom appeal using our database of millions of clinical studies, insurer policies, and legal standards. It includes your personal story, the clinical evidence that fits your condition and your denial, and an analysis aimed squarely at your insurer’s reasoning. We submit it to your insurer, and if you need to escalate, we guide you through that too.

Because we handle so many biologic appeals, we know which plans push a ustekinumab copy, which ones respond to step therapy exception requests, and which escalation paths actually work.

Appealing with Claimable costs $39.95. No success fees, no hidden costs. When Skyrizi runs around $23,800 a dose and going untreated can mean permanent joint damage, severe flares, or surgery, the cost of not appealing is a lot higher.

Start your Skyrizi appeal →

How Long Does a Skyrizi Appeal Take?

Complete appeals move faster. The average Claimable appeal gets a response in about 10 days.

FAQs

Why was my Skyrizi denied when my doctor prescribed it?
Almost every insurer requires prior authorization for Skyrizi, and their rules often go beyond what a normal prescription involves: making you try other drugs first, hitting certain severity thresholds, using a specific pharmacy. Your doctor made the medical call. The insurer is layering its own cost rules on top.

Can I appeal a Skyrizi denial myself?
Yes. Your appeal runs on a separate track from your doctor’s, with guaranteed response times, the right to an outside review, and several levels of internal appeal. Your appeal and your doctor’s work in parallel and strengthen each other.

My insurer wants me to try a Stelara biosimilar instead. Are they the same drug?
No. They work on different targets and have different data behind them. Stelara blocks both IL-23 and IL-12; Skyrizi blocks only IL-23. In head-to-head psoriasis studies, Skyrizi cleared skin better. If your insurer is treating them as equals, your appeal should spell out the difference and your doctor’s reason for choosing Skyrizi.

Is there a generic or biosimilar version of Skyrizi?
No. AbbVie is the only maker, and no copy is expected soon. Skyrizi is dispensed only through specialty pharmacies.

How much does Skyrizi cost without insurance?
The list price is about $23,838 per dose as of January 2026. For psoriasis and psoriatic arthritis, at four to five doses a year, that’s over $90,000 annually. If cost is a barrier, AbbVie’s Skyrizi Complete Savings Card can bring it down to as little as $0 a dose for people with eligible commercial insurance, and its myAbbVie Assist program may provide the drug free for people who qualify. What you’ll pay depends on your coverage, so check the details for your situation.

How is the dosing different for psoriasis versus Crohn’s or ulcerative colitis?
For psoriasis and psoriatic arthritis, Skyrizi is a 150 mg injection under the skin at weeks 0 and 4, then every 12 weeks. For Crohn’s, you start with three 600 mg IV infusions (weeks 0, 4, and 8). For ulcerative colitis, the infusions are the same schedule at a higher dose, 1,200 mg. After the infusions, both Crohn’s and ulcerative colitis patients switch to a 180 mg or 360 mg injection under the skin, starting at week 12 and every 8 weeks after that. The infusions are billed to your medical benefit, the injections to your pharmacy benefit.

Is it worth appealing a Skyrizi denial?
Almost always. Skyrizi is usually prescribed when your situation calls for a targeted drug, and for many people that means they’ve already tried other treatments. Left untreated, psoriatic disease can cause permanent joint damage, inflammatory bowel disease can lead to surgery, and gaps in biologic treatment risk flares and loss of response. The appeals process exists for exactly this: when a coverage decision doesn’t match your medical reality. Your doctor prescribed Skyrizi because the evidence supports it. An appeal forces the insurer to answer that evidence on the record.

Claimable’s physician-led team has helped patients recover over $30 million in care access by fighting insurance denials. We’re SOC 2 Type II certified and HIPAA compliant. Learn more about how Claimable works →