Diagnosis: Psoriasis.
Treatment: Skyrizi Pen 150 MG/ML (milligrams/milliliter) injection.
The insurer denied the Skyrizi Pen 150 MG/ML (milligrams/milliliter) injection.
The denial is overturned.

The patient is an adult female diagnosed with moderate to severe psoriasis involving the scalp, face and upper extremities. The patient has tried and failed methotrexate, topical steroids and calcipotriene. She is now being prescribed Skyrizi. The plan has denied the request for Skyrizi so the treating provider is appealing the denial.

The proposed treatment with Skyrizi is medically necessary.

The patient has failed one conventional systemic therapy. Due to the location of a sensitive area such as the scalp and face, treatment with ultraviolet (UV) therapy is contraindicated. Skyrizi has demonstrated superior efficacy over several biologic treatments. Thus, Skyrizi is medically necessary for this patient.

The patient has contraindications to a trial of ultraviolet therapy based on disease location. The treating provider has also indicated that due to the inability of the patient to receive regular treatments of phototherapy, the likelihood of treatment success is small.

Skyrizi is a superior treatment with no reported increase risk of skin cancer as seen with psoriasis patients receiving phototherapy, a treatment option that is no longer considered standard of care.

Per Brownstone, ND et al (2021): "Risankizumab has been shown to have very high efficacy in many comparison trials. It has superior efficacy to adalimumab, ustekinumab, and secukinumab. Though the onset of action is as fast as the IL-17 agent secukinumab, it achieved much better efficacy by week 52. Additionally, it has been noted to have high durability."

Per Blair, HA et al (2020): "In clinical trials, subcutaneous risankizumab was more effective than placebo, ustekinumab, adalimumab, secukinumab and fumaric acid esters in reducing the severity and extent of moderate to severe plaque psoriasis".

Armstrong AW et al (2020) reports: " brodalumab, guselkumab, ixekizumab, and risankizumab-rzaa were associated with the highest PASI response rates in both short-term and long-term therapy."