Does your insurance cover your IBD medication?
Pick your insurer, medication, and condition to see typical coverage, prior authorization, and step therapy requirements, all based on publicly available formulary policies.
Yes, Skyrizi is typically covered by Aetna, with prior authorization
Most Aetna commercial plans cover Skyrizi (risankizumab) for Crohn's disease, but your prescriber must submit clinical documentation before the plan will pay. Approval is common when criteria are met.
- Prior authorization
Required
Prescriber submits clinical documentation; decision times vary by plan, urgency, and how complete the submission is.
- Step therapy
None
No fail-first in the cited policy; individual plan formularies can still add rules.
- Typical placement
Varies by plan
CPB 1009 is a medical-benefit policy and does not set a pharmacy tier
- Line of business:
- Commercial
- Reauthorization:
- Continuation requires documented clinical response; no universal 12-month interval stated
- PA criteria:
- Moderate-to-severe active Crohn's disease; prescribed by or in consultation with a gastroenterologist; TB screening; labeled route and dosing; precertification required under CPB 1009. Continuation requires documented clinical benefit. No fail-first is listed in the base policy, though a plan's pharmacy formulary may add rules.
- Exception path:
- None specified
- Scope:
- Aetna commercial medical-benefit CPB 1009 for IV induction; SC maintenance is separate.
The access landscape for Crohn's disease
How restrictive each major insurer's standard commercial formulary is, per medication. Select any cell to see the details above.
- Prior auth
- PA + step therapy
- Brand excluded / off formulary
- Varies by local plan
Standard commercial policies; last reviewed Jul 2026. Coverage depends on your exact plan, employer group, state, and whether the drug is infused (medical benefit) or self-injected (pharmacy benefit). Blue Cross Blue Shield coverage is set by independent local Blue companies, and Kaiser Permanente details reflect Kaiser Northwest policy documents. This tool summarizes publicly available policies and is for informational purposes only. It is not medical or insurance advice.