If you or someone you care for takes Skyrizi, you’ve probably wondered whether Medicare will help pay for it. The short answer is yes — Medicare can cover Skyrizi for its approved uses. The trickier part is which piece of Medicare pays, because that depends on how and why you’re getting it.
What Skyrizi treats
Skyrizi (the brand name for risankizumab) is a biologic medicine. It’s FDA-approved to treat plaque psoriasis, psoriatic arthritis, and Crohn’s disease. Biologics are made from living cells and tend to be more complex — and more expensive — than ordinary pills, which is why coverage rules around them are a little more involved.
How you receive Skyrizi can differ by condition. For psoriasis, it’s typically self-injected at home. For Crohn’s disease, the first round of treatment usually starts with an IV infusion given in a clinic, with self-injected doses later on. That difference matters for Medicare, as you’ll see below.
Brand vs. generic
Skyrizi is brand-only right now — there’s no generic or biosimilar version available yet. That’s worth knowing because generics and biosimilars tend to sit on a plan’s lower-cost tiers. With a brand-only biologic like Skyrizi, plans most often place it on a higher brand or specialty tier, which usually means a larger copay or coinsurance.
How Medicare covers it
This is where Skyrizi is a little different from many drugs, because it can fall under two different parts of Medicare depending on how it’s given.
- Self-injected at home (common for psoriasis): Because you administer it yourself, it’s typically covered under Medicare Part D — your prescription drug benefit — usually on a specialty tier.
- Given by IV infusion in a clinic (the initial Crohn’s “induction” doses): A drug administered by a provider may be billed under Medicare Part B instead, the way other in-office infusions often are.
For Crohn’s specifically, this can mean the induction doses run through Part B, while the later self-injected maintenance doses run through Part D. In other words, which part pays can depend on how and why the drug is being given.
Here’s the catch that trips a lot of people up on the Part D side: every Part D and Medicare Advantage drug plan has its own formulary (its list of covered drugs), and each plan decides which tier a drug lands on. Coverage and tier vary from plan to plan and can change each year. That’s exactly why checking your own plan matters. Our Formulary Lookup lets you see how Skyrizi is treated on a specific plan, and the Drug Cost Calculator helps you estimate what you’d actually pay across the year.
Coverage rules to expect
Even when Skyrizi is covered, getting it approved isn’t always automatic. With a specialty biologic, a few tools are common:
- Prior authorization (PA). Your plan will likely ask your doctor to submit documentation confirming you’re using Skyrizi for an approved condition before it covers the prescription. This is very common for biologics.
- Step therapy. Some plans ask you to try a preferred, often lower-cost medicine first, and show it didn’t work well enough, before they’ll cover Skyrizi.
- Quantity limits. Your plan may cover only a set amount per fill or period without an approved exception.
None of these are dead ends — they’re just steps, and your doctor’s office handles them all the time. If you’d like a plain-English walkthrough, see our guides on prior authorization and step therapy.
Coverage exceptions and appeals
If Skyrizi isn’t on your plan’s formulary, or it’s on a higher tier than you’d like, you have options. You and your prescriber can request a coverage exception — asking the plan to cover a non-formulary drug, or to move it to a lower tier. Your doctor explains why this drug is medically appropriate for you. If the plan says no, you have appeal rights and can ask it to reconsider. These requests are routine, and they exist for situations exactly like this.
Alternatives to discuss with your doctor
If cost or coverage rules become a hurdle, the best move is a conversation with your doctor — never a change you make on your own. There are other biologics approved for psoriasis, psoriatic arthritis, and Crohn’s disease that your doctor might consider, and the right alternative depends on your specific condition. Each works a little differently and may sit on a different tier or have different rules on your plan. You can read more in our guides on Humira and Rinvoq. Your doctor can help decide what fits your health needs best.
Questions to ask your doctor
- Is Skyrizi still the right choice for my condition?
- Will my doses be self-injected, given by infusion, or both — and how might that affect which part of Medicare pays?
- If my plan requires prior authorization or step therapy, can your office help with the paperwork?
- Are there other biologics that might work as well and cost me less?
A friendly next step
Skyrizi coverage comes down to two things: how and why you’re taking it, and the fine print of your particular plan. If you’re not sure whether your costs run through Part B or Part D — or you’re shopping for a plan that handles your medications well — I’m happy to walk through it with you, no pressure. You can reach out anytime and we’ll look at your formulary and costs together.
Medical & coverage disclaimer: This article is general education — not medical advice or a guarantee of coverage. Whether a specific drug is covered, and what you’ll pay, depends on your individual Part D or Medicare Advantage plan, its formulary, and the plan year, and can change. Always confirm with your plan or a licensed agent, and talk to your doctor about your treatment.