Diagnosis: Psoriasis (scalp).
Treatment: Skyrizi Pen 150MG/ML (milligrams/milliliters) Pen Injector.

The insurer denied: Skyrizi Pen 150MG/ML (milligrams/milliliters) Pen Injector.
The denial is overturned.

The patient a young adult male with scalp psoriasis, 10% BSA (body surface area), treated with topical medications and intralesional steroid injections. His provider is requesting treatment with Skyrizi. The health plan requires use of systemic immunosuppressant therapy.

The requested Skyrizi is medically necessary.

Skyrizi is an approved, appropriate and effective medication for psoriasis. A number of biologic agents are available for the treatment of moderate-to-severe plaque psoriasis. Currently, the selection of the first biologic, and the choice of sequential biologics in the event of efficacy/tolerability concerns, is made using a limited evidence base. Skyrizi is among the most effective therapies for psoriasis according to current peer-reviewed literature.

According to the meta-analysis by Sbidian et al, compared to placebo, the biologics infliximab, ixekizumab (Taltz), risankizumab (Skyrizi), bimekizumab, secukinumab (Cosentyx), guselkumab (Tremfya) and brodalumab were the most effective treatments for achieving PASI 90 (90% reduction in Psoriasis Area and Severity Index score) in people with moderate-to-severe psoriasis on the basis of moderate- to high-certainty evidence.

Methotrexate would not be the most appropriate medication for a male of childbearing potential. Prescribing information for methotrexate states that males must use "effective contraception during treatment and for at least 3 months after discontinuation." Acitretin and cyclosporine are not used for plaque psoriasis.

Therefore, given the above, the requested Skyrizi is medically necessary.