Risankizumab-rzaa

Covers risankizumab‑rzaa (Skyrizi) intravenous induction (600 mg IV at Weeks 0, 4, and 8) with subsequent subcutaneous dosing for treatment of adults (≥18) with moderate to severely active Crohn’s disease and ulcerative colitis. Coverage is limited to patients meeting specified activity criteria (e.g., CDAI 220–450 and SES‑CD thresholds), typically those with inadequate response or intolerance to prior therapies/biologic failure; the first three doses must be administered in a healthcare setting by a provider, maintenance is restricted to initial responders, IV use outside FDA‑approved indications is not covered, and self‑administered formulations fall under the pharmacy benefit.

"Therapies that are proven effective for the relevant diagnosis or procedure based on generally accepted clinical standards."

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