Alternatives to Skyrizi If You Can't Fill Your Prescription

When you can't get Skyrizi filled—whether due to insurance denial, step therapy requirements, prior authorization delays, or cost—it can feel like you're out of options. But the good news is that several effective alternatives exist. Depending on your condition, your medical history, and your insurance plan, one or more of these drugs may be accessible to you faster. Always discuss alternatives with your prescribing specialist before making any changes.

Why Might You Need a Skyrizi Alternative?

There are several common reasons patients and providers explore alternatives to Skyrizi:

Insurance denial or step therapy requirements mandating a different biologic first

Prior authorization delays creating an unacceptable gap in treatment

High cost even after savings programs, especially for patients without commercial insurance

Inadequate response to Skyrizi after a treatment trial

A comorbid condition that makes a different biologic more appropriate (e.g., additional inflammatory conditions)

IL-23 Inhibitor Alternatives in the Same Drug Class

Skyrizi belongs to the IL-23 inhibitor class. Other medications in the same class work by similar mechanisms and may be covered differently by your insurance:

Tremfya (guselkumab) — Like Skyrizi, Tremfya is an IL-23 inhibitor (targets the p19 subunit of IL-23) used for plaque psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease. It is given every 8 weeks for maintenance after loading doses. Tremfya has seen rapid adoption and is a direct competitor in the same drug class. If Skyrizi is not on your formulary but Tremfya is, switching may be clinically appropriate with your doctor's guidance.

Ilumya (tildrakizumab) — Another IL-23 inhibitor, Ilumya is FDA-approved specifically for moderate-to-severe plaque psoriasis in adults. It is given every 12 weeks after two loading doses. Ilumya is not approved for PsA, Crohn's, or UC, so it is only an option for psoriasis patients.

Omvoh (mirikizumab) — Omvoh is an IL-23 inhibitor approved for ulcerative colitis and Crohn's disease. It is given as an IV induction followed by subcutaneous maintenance injections every 4 weeks. If you have UC or CD and can't access Skyrizi, Omvoh is another option in the same class.

IL-12/23 Inhibitor Alternatives

Stelara (ustekinumab) — Stelara blocks both IL-12 and IL-23 and is approved for plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. Importantly, multiple biosimilar versions of Stelara are now available (including Wezlana, Otulfi, and others), which can significantly reduce cost. Stelara is given every 12 weeks. For patients with both psoriasis and IBD, Stelara's long track record and growing biosimilar market make it a commonly covered alternative.

TNF Inhibitor Alternatives

TNF inhibitors are often the drugs insurers require patients to try first (step therapy) before approving Skyrizi. If you are early in your treatment journey, your plan may require trying one of these before Skyrizi:

Humira (adalimumab) and its biosimilars — Adalimumab is available as Humira and numerous lower-cost biosimilars (Hadlima, Hyrimoz, Cyltezo, and others). It treats psoriasis, PsA, Crohn's, and UC. Biosimilars have significantly reduced costs, making adalimumab more accessible for some patients.

Cosentyx (secukinumab) — An IL-17A inhibitor used for plaque psoriasis, PsA, and ankylosing spondylitis. It works differently from Skyrizi but is an established alternative for psoriasis and PsA.

Oral Alternatives

Otezla (apremilast) — An oral phosphodiesterase 4 (PDE4) inhibitor for plaque psoriasis and psoriatic arthritis. It is taken as a pill twice daily, which some patients prefer. It has a different safety profile than biologics and does not require TB screening or injection training. It may be a step therapy option prior to biologic approval.

Rinvoq (upadacitinib) — An oral JAK inhibitor used for PsA, Crohn's disease, UC, and other inflammatory conditions. Important note: Rinvoq (upadacitinib) is contraindicated with Skyrizi—these two drugs should NOT be used together due to combined immunosuppression risk.

How to Discuss Alternatives With Your Doctor

When you're considering a switch or alternative, share these key details with your specialist: your insurance plan's formulary tier for each option, whether you have other inflammatory conditions that might respond better to a specific drug, your preference for injection vs. oral, and your access to infusion centers if IV induction is needed. See also Why Is Skyrizi So Hard to Find? for tips on navigating insurance barriers.

If you've settled on a specific medication after discussing with your doctor, medfinder can help you locate which pharmacies near you can fill your prescription, saving you time and phone calls.