Skyrizi Prior Authorization Resources

Find the right PA form for your patient's payer, get the ICD-10 codes you need, and download appeal templates — all in one place.

Last verified: May 11, 2026

Blue Cross Blue Shield of Arkansas - Pharmacy Prior Authorization Form Arkansas Blue Cross Blue Shield · Updated May 11, 2026
Blue Cross of Idaho - General Prior Authorization Form Blue Cross of Idaho Health Services, Inc. · Updated May 11, 2026
California - Uniform Prior Authorization FormCalifornia · Updated May 16, 2026
CDPHP - General Prior Authorization FormCapital District Physicians Health Plan, Inc. · Updated May 11, 2026
Cigna - General Medication Prior Authorization FormCigna Corporation · Updated May 11, 2026
Cigna - Skyrizi IV Prior Authorization Form Cigna Corporation · Updated May 16, 2026

ICD-10 codes for Skyrizi Prior Authorizations

L40.9Psoriasis, unspecified
L40.50Arthropathic psoriasis, unspecified
K50.9Crohn's disease, unspecified
K51.9Ulcerative colitis, unspecified

Appeal Templates

If the payer denies coverage, these templates help you build a stronger appeal.
Coverage Authorization Appeals: DermatologyCoverage Authorization Appeals: Dermatology resource
Letter of Medical Necessity: DermatologyLetter of Medical Necessity: Dermatology resource
Formulary Exception Letter: DermatologyFormulary Exception Letter: Dermatology resource
Coverage Authorization Appeals: RheumatologyCoverage Authorization Appeals: Rheumatology resource
Letter of Medical Necessity: RheumatologyLetter of Medical Necessity: Rheumatology resource
Formulary Exception Letter: RheumatologyFormulary Exception Letter: Rheumatology resource
Coverage Authorization Appeals: GastroenterologyCoverage Authorization Appeals: Gastroenterology resource
Letter of Medical Necessity: GastroenterologyLetter of Medical Necessity: Gastroenterology resource
Formulary Exception Letter: GastroenterologyFormulary Exception Letter: Gastroenterology resource
A peer-to-peer review with the payer's medical director can often resolve denials faster than a formal appeal.

Brand Resources

Pharmacy List Pharmacy List resource
Billing and Coding Guide Billing and Coding Guide resource
Formulary Information: Plaque PsoriasisFormulary Information: Plaque Psoriasis resource
Tiered Exception Letter: DermatologyTiered Exception Letter: Dermatology resource
Tiered Exception Letter: RheumatologyTiered Exception Letter: Rheumatology resource
Navigating PA: Plaque Psoriasis & Psoriatic ArthritisNavigating PA: Plaque Psoriasis & Psoriatic Arthritis resource
Letter of Medical Exception: GastroenterologyLetter of Medical Exception: Gastroenterology resource
Tiered Exception Letter: GastroenterologyTiered Exception Letter: Gastroenterology resource
Navigating PA: Crohn's Disease & Ulcerative ColitisNavigating PA: Crohn's Disease & Ulcerative Colitis resource

Support for Getting Your Patient on Skyrizi

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