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ACCESS & REIMBURSEMENT
BENEFIT VERIFICATION & PRIOR AUTHORIZATION SUPPORT FOR MEDICAL AND PHARMACY BENEFITS
Enroll your patients into Complete for support and potential savings for your patients
SPECIALTY PHARMACIES AND DISTRIBUTORS
A complete list of specialty pharmacies that provide On-Body Injector (OBI) support for SKYRIZI.
WHOLESALE AND SPECIALTY DISTRIBUTORS
A complete list of wholesalers and specialty
distributors that provide intravenous (IV) infusion support for SKYRIZI.
SKYRIZI NDCs
Two single-dose vials are needed per induction dose for UC. Order two cartons of NDC 0074-5015-01 for each induction dose that is needed.
Single-dose Vial
600 mg/10.0 mL
0074-5015-01
Carton of 1
Single-dose Prefilled Cartridge
With On-Body Injector (OBI)
180 mg/1.2 mL
0074-1065-01
Kit
Single-dose Prefilled Cartridge
With OBI
360 mg/2.4 mL
0074-1070-01
Kit
NDC=National Drug Code.
ACCESS AND REIMBURSEMENT FORMS
Along with support from SKYRIZI Complete, you can use the forms here to help patients with access and coverage for SKYRIZI. For support in person or over the phone, call your access specialist at 1.877.COMPLETE (1.877.266.7538).
Prior Authorization Instructions
Follow this helpful checklist to request coverage of SKYRIZI.
SKYRIZI Appeal Letter (Example)
Appeal a denied claim for SKYRIZI.
SKYRIZI Letter of Medical Necessity
Establish the medical necessity of SKYRIZI.
SKYRIZI Letter of Medical Exception
Formulary Exception Letter
Request a formulary exception to allow coverage for SKYRIZI.
Tiered Exception Letter
Request lower cost sharing for SKYRIZI as a preferred medication.
HIPAA Authorization
Allow patients to authorize the release of health information related to their treatment with SKYRIZI.
Assist patients with SKYRIZI IV costs
Utilize this form as a guide when submitting patient claims for reimbursement for eligible, commercially insured patients using the SKYRIZI Complete Savings Card.
HIPAA=Health Insurance Portability and Accountability Act.
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An opportunity for endoscopic control.1
SKYRIZI BILLING & CODING
Get information about billing and coding and download a helpful guide.
