What is Skyrizi and How is it Used?

Skyrizi (risankizumab-rzaa) is a biologic medication manufactured by AbbVie that works as an interleukin-23 (IL-23) inhibitor. It specifically targets a protein that causes inflammation in the body, helping to reduce the symptoms of certain autoimmune conditions.

The medication is FDA-approved for treating moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy. In 2022, its approval expanded to include active psoriatic arthritis. Skyrizi is typically administered as an injection, with an initial starting dose followed by maintenance injections every 12 weeks, making it less frequent than many comparable treatments.

Patients usually receive their first two starter doses (150 mg each) at weeks 0 and 4, then continue with 150 mg injections every 12 weeks thereafter. The medication comes in prefilled pens or syringes that patients can administer at home after proper training from a healthcare provider.

Skyrizi Cost Breakdown

The cost of Skyrizi without insurance is significant, with the average wholesale price approximately $18,000-$20,000 per dose. Since patients typically receive five doses in the first year (two starter doses plus three maintenance doses), the annual cost can reach $90,000-$100,000 for the first year of treatment.

In subsequent years, patients usually require four maintenance doses annually, bringing the yearly cost to approximately $72,000-$80,000 without any insurance coverage or assistance programs. These figures represent the list price, which is the manufacturer's published price for the medication.

It's important to understand that most patients don't pay this full amount out-of-pocket due to insurance coverage, manufacturer assistance programs, and other financial support options. The actual cost to patients varies significantly based on their insurance status, plan details, and eligibility for various assistance programs.

Insurance Coverage for Skyrizi

Most private insurance plans, Medicare Part D, and many Medicaid programs provide some coverage for Skyrizi, though the extent varies widely. With private insurance, patients may be responsible for a coinsurance percentage (typically 20-30% of the drug cost) or a fixed copay amount per prescription fill.

For Medicare Part D beneficiaries, coverage falls under the prescription drug benefit. However, patients may face significant out-of-pocket costs due to the Medicare coverage gap (donut hole) and coinsurance requirements. In 2023, once patients and their plans have spent a certain amount on covered drugs, they enter the coverage gap where they pay a higher percentage of costs until reaching catastrophic coverage.

Most insurance plans require prior authorization for Skyrizi, meaning your doctor must provide clinical documentation proving medical necessity before the insurance will approve coverage. This typically includes evidence that you have the diagnosed condition and have tried and failed other treatments. Some insurers implement step therapy requirements, mandating that patients try less expensive alternatives before approving Skyrizi.

Medication Assistance Programs Comparison

Several programs can help reduce out-of-pocket costs for Skyrizi. Below is a comparison of the main assistance options:

Program Eligibility Potential Savings
AbbVie's Skyrizi Complete Commercially insured patients As little as $5 per dose
AbbVie Patient Assistance Foundation Uninsured or financially struggling patients Free medication for qualified individuals
NeedyMeds Various programs for different situations Varies by program
Partnership for Prescription Assistance Connects patients to assistance programs Varies by program

The Skyrizi Complete program offers comprehensive support including a savings card that can reduce commercially insured patients' out-of-pocket costs to as little as $5 per dose. The program also provides insurance support services, helping patients navigate coverage issues and prior authorizations.

For uninsured patients or those facing financial hardship, the AbbVie Patient Assistance Foundation may provide free medication to eligible individuals. Qualification is based on financial need, residency status, and other factors.

Independent organizations like NeedyMeds and Partnership for Prescription Assistance connect patients with various pharmaceutical assistance programs, government resources, and discount options that can help reduce medication costs.

Strategies to Manage Skyrizi Costs

Beyond manufacturer programs and insurance coverage, patients can employ several strategies to help manage Skyrizi costs:

Work closely with healthcare providers - Doctors can help document medical necessity thoroughly for insurance approvals and may know about additional assistance resources. Some dermatology practices and rheumatology clinics have dedicated staff who specialize in helping patients navigate insurance and financial assistance for biologic medications.

Appeal insurance denials - If your insurance initially denies coverage, you have the right to appeal. Your doctor can provide supporting documentation about why Skyrizi is medically necessary for your specific condition. Statistics show that a significant percentage of appeals are successful when properly documented.

Explore clinical trials - For some patients, participating in a clinical trial related to Skyrizi or similar medications may provide access to treatment at reduced or no cost. While not a long-term solution, this can help offset costs temporarily.

Consider HSA/FSA accounts - If you have access to a Health Savings Account (HSA) or Flexible Spending Account (FSA), these tax-advantaged accounts can help manage out-of-pocket medication costs more effectively.

Investigate nonprofit assistance - Organizations like the Patient Advocate Foundation or the National Psoriasis Foundation sometimes offer copay assistance or can connect patients with resources specific to their condition and treatment needs.

Conclusion

Managing the cost of Skyrizi requires understanding your insurance coverage, exploring manufacturer assistance programs, and potentially utilizing additional resources from nonprofit organizations. While the list price is substantial, most patients don't pay the full amount thanks to these various support options. For those considering Skyrizi treatment, discussing financial concerns with your healthcare provider early in the process is essential. They can help navigate the complex landscape of biologic medication costs and identify the most appropriate financial assistance programs for your specific situation. With proper planning and utilization of available resources, this effective treatment can be more financially accessible for many patients with moderate to severe plaque psoriasis or psoriatic arthritis.

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This content was written by AI and reviewed by a human for quality and compliance.