Editorial note: This article is for educational purposes only. It is not medical advice, insurance advice, or a substitute for talking with your prescriber, Medicare plan, pharmacist, or State Health Insurance Assistance Program counselor.
Skyrizi is one of those medications that can sound like a futuristic ski resort but is actually a prescription biologic used for several immune-related conditions. If your doctor has recommended it and you have Medicare, your next question is probably not, “How does interleukin-23 inhibition work?” It is more likely, “Will Medicare cover Skyrizi, and how much is this going to cost me?”
The answer is encouraging but not one-size-fits-all: Medicare may cover Skyrizi when it is medically necessary and your plan includes the drug or approves it through a coverage request. Your actual cost depends on which part of Medicare pays, your diagnosis, how the drug is given, your plan’s formulary, whether prior authorization is required, and whether you qualify for help such as Extra Help or a patient assistance program.
This guide breaks down Medicare and Skyrizi coverage, cost, savings options, plan rules, and practical steps to avoid surprise bills. Think of it as your map through the Medicare maze, minus the Minotaur and hopefully minus the hold music.
What Is Skyrizi?
Skyrizi, also known by its generic name risankizumab-rzaa, is a biologic medicine that targets interleukin-23, or IL-23, a protein involved in inflammation. By blocking part of this inflammatory pathway, Skyrizi can help reduce symptoms in certain immune-mediated diseases.
Conditions Skyrizi May Treat
In the United States, Skyrizi is approved for adults with several conditions, including:
- Moderate to severe plaque psoriasis in adults who may benefit from systemic therapy or phototherapy
- Active psoriatic arthritis
- Moderately to severely active Crohn’s disease
- Moderately to severely active ulcerative colitis
The way Skyrizi is given depends on the condition being treated. For plaque psoriasis and psoriatic arthritis, it is typically given as a subcutaneous injection at the start of treatment, again at Week 4, and then every 12 weeks. For Crohn’s disease and ulcerative colitis, treatment commonly begins with intravenous induction doses given by a healthcare professional, followed by maintenance injections or an on-body injector every 8 weeks.
Does Medicare Cover Skyrizi?
Yes, Medicare may cover Skyrizi, but coverage is not automatic in every situation. The most important detail is whether Skyrizi is billed under Medicare Part B or Medicare Part D. That distinction can dramatically change your out-of-pocket cost.
When Skyrizi May Be Covered by Medicare Part D
Medicare Part D is prescription drug coverage. It is available through stand-alone Part D plans or Medicare Advantage plans that include drug coverage. Skyrizi maintenance doses that are self-administered at home, such as prefilled syringes, pens, cartridges, or on-body injectors, are often processed through Part D if the drug is on your plan’s formulary or approved through an exception.
Because Skyrizi is a high-cost biologic, it is usually treated as a specialty medication. Many Medicare drug plans place specialty drugs on higher tiers and may require extra steps before they approve payment.
When Skyrizi May Be Covered by Medicare Part B
Medicare Part B covers certain outpatient drugs, especially medications that are not usually self-administered and are given in a doctor’s office, infusion center, or hospital outpatient setting. If you receive Skyrizi as an intravenous infusion for Crohn’s disease or ulcerative colitis, the induction doses may be billed under Part B, depending on your plan, provider, and treatment setting.
For people with Original Medicare, Part B usually pays 80% of the Medicare-approved amount after the Part B deductible is met, and the patient is responsible for the remaining 20% unless they have supplemental coverage such as Medigap, Medicaid, retiree coverage, or another secondary payer. With Medicare Advantage, costs vary by plan and network rules.
How Much Does Skyrizi Cost With Medicare?
There is no single Medicare price for Skyrizi. Your cost may be very low, very high, or somewhere in between, depending on your plan. The list price for Skyrizi is more than $23,000 for certain single-dose forms, but list price is not the same as what a Medicare beneficiary pays. Plans negotiate pricing, apply formularies, and calculate member cost-sharing according to Medicare rules.
Important 2026 Medicare Part D Cost Rules
For 2026, Medicare Part D has an annual out-of-pocket cap of $2,100 for covered Part D drugs. This cap can be especially important for people taking expensive biologics such as Skyrizi. If Skyrizi is covered under your Part D plan, your spending for covered Part D medications should count toward that annual out-of-pocket limit.
Part D plans may also have a deductible. In 2026, no Medicare drug plan can have a deductible higher than $615, although some plans have lower or no deductibles. If Skyrizi is subject to the deductible, you may pay more at the beginning of the year until the deductible and other cost-sharing rules are satisfied.
The Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan can help people spread out covered Part D drug costs across the year instead of paying a large amount at the pharmacy counter all at once. This payment option does not lower the total cost of Skyrizi, but it may make budgeting easier. In plain English: it is more like turning a mountain into monthly hills. Still uphill, but less likely to make your wallet gasp.
Why Your Skyrizi Cost May Vary
Two people can both have Medicare and both take Skyrizi, yet pay very different amounts. The difference usually comes down to plan design and billing path.
1. Your Plan’s Formulary
A formulary is a plan’s list of covered drugs. Skyrizi may be listed on one Medicare Part D plan but not another. Even when it is listed, it may appear on a specialty tier with higher cost-sharing. Always search for “Skyrizi” and “risankizumab-rzaa” in your plan’s formulary before enrolling or switching plans.
2. Prior Authorization
Prior authorization means your doctor must send information to the plan showing that Skyrizi is medically necessary. The plan may want documentation of your diagnosis, disease severity, previous treatments, lab tests, or treatment goals. This is paperwork, yes, but for specialty drugs it is also very common.
3. Step Therapy
Some plans may require step therapy. This means you may need to try one or more lower-cost or preferred treatments first, unless your doctor explains why those options are not appropriate for you. If you have already tried other biologics, topical therapies, immunosuppressants, or anti-inflammatory medications, make sure your provider documents that history clearly.
4. Quantity Limits
A plan may limit how much Skyrizi it will cover within a certain time period. Quantity limits are designed to match approved dosing schedules, but they can cause delays if the prescription is written differently than the plan expects.
5. Pharmacy or Infusion Network
For Part D, Skyrizi may need to come from a specialty pharmacy. For Part B or Medicare Advantage medical-benefit coverage, your infusion site or provider may need to be in network. Using the wrong pharmacy or facility can turn an already expensive medication into a financial jump scare.
Can You Use a Skyrizi Savings Card With Medicare?
Usually, no. Manufacturer copay cards are generally designed for people with commercial insurance. Skyrizi’s commercial savings program is not available to people whose medication is reimbursed through Medicare, Medicare Advantage, Medicare Part D, Medicaid, TRICARE, Veterans Affairs, or other government-funded programs.
That does not mean there are no savings options. It means Medicare beneficiaries need to look at other routes, such as Extra Help, plan comparison, formulary exceptions, patient assistance programs, or nonprofit support when available.
Ways to Lower Skyrizi Costs on Medicare
Apply for Extra Help
Extra Help, also called the Low-Income Subsidy, helps eligible Medicare beneficiaries pay Part D premiums, deductibles, and prescription drug cost-sharing. In 2026, people who qualify may pay little or nothing for plan premiums and deductibles, and copays for covered brand-name drugs may be sharply reduced. If Skyrizi is financially out of reach, Extra Help should be one of the first programs to check.
Compare Medicare Plans Every Year
Medicare plans can change formularies, premiums, pharmacy networks, deductibles, and drug tiers each year. A plan that works beautifully this year may become a pumpkin carriage next year. During Medicare Open Enrollment, compare plans using your exact prescriptions, dosage, pharmacy, and location.
Ask About a Formulary Exception
If your plan does not cover Skyrizi, your prescriber may request a formulary exception. If the drug is covered but placed on a high-cost tier, your provider may request a tiering exception when allowed. The plan will usually require a medical explanation, such as why covered alternatives are not appropriate or have already failed.
Use the Right Billing Channel
For Crohn’s disease or ulcerative colitis, ask whether induction infusions are billed under Part B or Part D. Then ask how maintenance doses will be billed. This matters because Part B and Part D have different deductibles, caps, coinsurance rules, and assistance options.
Check Medigap or Secondary Coverage
If Skyrizi is billed under Original Medicare Part B, a Medigap policy may help cover the 20% coinsurance. Medigap does not pay Part D drug copays, but it can be useful for Part B services. People with Medicaid, employer retiree coverage, union coverage, or other secondary insurance should ask how coordination of benefits works before starting treatment.
Ask About myAbbVie Assist
AbbVie has a patient assistance program that may help eligible patients receive medications at no cost. Medicare beneficiaries may have additional requirements, and some may need to apply for or be denied Extra Help before being evaluated. Program rules can change, so patients should verify eligibility directly.
Questions to Ask Before Starting Skyrizi
Before the first dose, make a short checklist. It may save hours later, and possibly a few gray hairs.
- Is Skyrizi covered by my Medicare plan for my diagnosis?
- Will this dose be billed under Part B or Part D?
- Do I need prior authorization?
- Does my plan require step therapy?
- Which specialty pharmacy or infusion center must I use?
- What will I pay for the first dose, maintenance doses, and the rest of the year?
- Will my costs count toward the 2026 Part D out-of-pocket cap?
- Should I apply for Extra Help or patient assistance?
- What happens if coverage is denied?
Safety and Medical Considerations
Skyrizi can be effective for some people, but it is not a casual “take one and see what happens” medication. It affects the immune system and may increase the risk of infections. Before starting treatment, your healthcare provider may check for tuberculosis, review your infection history, evaluate vaccines, and discuss whether any live vaccines should be avoided during treatment.
People being treated for Crohn’s disease or ulcerative colitis may need additional monitoring, including liver-related tests during induction, depending on their medical situation. Tell your doctor if you have signs of infection, fever, unexplained fatigue, yellowing of the skin or eyes, dark urine, severe abdominal pain, or allergic reaction symptoms.
Also tell your care team about all medications, supplements, and vaccines. Medicare coverage is important, but safety comes first. A perfectly approved prescription is not helpful if your care team does not have the full picture.
Example Cost Scenarios
Example 1: Part D Coverage With a High-Cost Start
Maria has Medicare Part D and takes Skyrizi for plaque psoriasis. Her plan covers Skyrizi but places it on a specialty tier. At the beginning of 2026, she may pay deductible and coinsurance amounts until her out-of-pocket spending reaches the annual Part D cap. After reaching the cap for covered Part D drugs, she should owe $0 for covered Part D drugs for the rest of the year.
Example 2: Extra Help Makes the Difference
James has limited income and qualifies for Extra Help. His Skyrizi prescription is covered by his Medicare drug plan after prior authorization. Instead of facing high specialty-drug cost-sharing, he pays reduced copays under Extra Help rules. For him, applying for assistance is not a small detail; it is the bridge between “recommended by my doctor” and “actually possible.”
Example 3: Infusion First, Injection Later
Linda starts Skyrizi for Crohn’s disease. Her induction infusions are given at an outpatient infusion center and may be handled under the medical benefit, while her later maintenance doses may shift to pharmacy-benefit coverage. She asks both her gastroenterologist’s office and Medicare plan to confirm how each phase is billed before the first appointment.
Common Mistakes to Avoid
Do not assume your neighbor’s Medicare cost will be your cost. Medicare coverage is personal, local, and plan-specific. Also avoid starting treatment before prior authorization is complete unless your provider has confirmed the financial risk. Another mistake is checking only the monthly premium when choosing a Part D plan. A low-premium plan that does not cover Skyrizi can be far more expensive than a higher-premium plan that covers it well.
Finally, do not ignore denial letters. Medicare drug denials often include appeal rights and deadlines. If your plan denies Skyrizi, your prescriber can help provide medical documentation for an appeal or exception request.
Real-Life Experiences: What Medicare Patients Often Learn While Trying to Get Skyrizi Covered
For many Medicare beneficiaries, the Skyrizi journey begins with relief. After months or years of symptoms from psoriasis, psoriatic arthritis, Crohn’s disease, or ulcerative colitis, hearing that there is another treatment option can feel like someone finally opened a window in a stuffy room. Then the insurance conversation starts, and suddenly that window has paperwork taped over it.
One common experience is surprise at how many people are involved. A patient may start with the specialist, then speak with the office biologics coordinator, the specialty pharmacy, the Medicare drug plan, the infusion center, and sometimes a patient assistance program. It can feel like planning a wedding where every guest needs a separate authorization form. The good news is that many specialty practices are used to this process. Dermatology, rheumatology, and gastroenterology offices often have staff who handle prior authorizations every day. Patients who ask, “Who in your office helps with biologic approvals?” usually get farther faster.
Another common experience is sticker shock. Even when patients know biologics are expensive, seeing a list price above $20,000 per dose can cause a dramatic pause. The important point is that list price is not the same as the patient’s final Medicare cost. However, it is still a warning sign that details matter. Patients often learn to ask for an estimated cost before each phase of treatment, especially when moving from infusion induction to maintenance injections.
Some people also discover that timing matters. Starting Skyrizi early in the year may mean reaching the Part D out-of-pocket cap sooner, while starting later may create different monthly budgeting concerns. The Medicare Prescription Payment Plan may help smooth expenses, but it does not erase them. Patients who live on fixed incomes often benefit from asking the plan to explain both the “pay at the pharmacy” option and the monthly payment option in plain numbers.
Patients with Extra Help often describe a very different experience. Instead of worrying about massive cost-sharing, they may pay much smaller copays for covered drugs. The challenge is that not everyone who qualifies realizes they should apply. People who have recently retired, lost income, become widowed, or entered Medicare after disability may be especially likely to overlook assistance programs. A five-minute eligibility check can sometimes change the entire financial picture.
Another practical lesson: keep records like your treatment depends on it, because sometimes it does. Save denial letters, approval notices, pharmacy messages, lab results, and notes about previous medications you tried. If step therapy or prior authorization becomes an issue, documentation can help your doctor explain why Skyrizi is medically appropriate. A simple folder, digital or paper, can become your insurance survival kit.
Finally, many patients learn that persistence is not being difficult; it is being prepared. If a claim is denied, ask why. If the reason is missing information, ask who needs to send it. If the drug is not on the formulary, ask about an exception. If the cost is too high, ask about Extra Help, patient assistance, plan comparison, and whether the drug is being billed under the correct Medicare benefit. The process may not be charming, but it is navigable. Bring patience, bring questions, and maybe bring snacks.
Conclusion
Medicare may cover Skyrizi, but the details matter. Your coverage may run through Part D for self-administered maintenance doses or through Part B for certain provider-administered infusions. Your cost depends on your plan, formulary, diagnosis, prior authorization requirements, pharmacy or infusion network, and eligibility for assistance.
The most important steps are simple: confirm whether Skyrizi is covered, ask how each dose will be billed, check your estimated cost before treatment, apply for Extra Help if eligible, and request an exception or appeal if coverage is denied. Skyrizi is complicated enough medically; the billing side should not be a guessing game with a five-digit price tag lurking behind the curtain.
