Skyrizi

How Does Skyrizi Work?

Skyrizi works by selectively binding to the p19 subunit of interleukin-23 (IL-23), a key cytokine that drives inflammation in autoimmune diseases. By blocking IL-23 from interacting with its receptor on immune cells (particularly Th17 cells), Skyrizi interrupts the inflammatory cascade responsible for the symptoms of plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis.

Skyrizi's p19-selective targeting is more precise than older IL-12/23 inhibitors like ustekinumab (Stelara), which block both IL-12 and IL-23. By leaving IL-12 signaling intact, Skyrizi may have a more targeted safety profile. Clinical pharmacokinetic studies have confirmed that Skyrizi does not significantly interact with common CYP enzyme substrates, meaning it has a low potential for drug-drug interactions with most commonly prescribed medications.

In clinical trials for plaque psoriasis, Skyrizi demonstrated faster onset compared to ustekinumab—44% of patients achieved PASI 90 (90% skin clearance) by week 4. For Crohn's disease, the IV induction phase initiates the reduction of intestinal inflammation. As a maintenance therapy, Skyrizi must be continued long-term; stopping treatment typically results in disease return.

How Hard Is It to Find Skyrizi in Stock?

Skyrizi is not on the FDA Drug Shortage list as of 2026. The drug is commercially available through specialty pharmacy distribution networks in all its formulations. However, patients frequently encounter significant access barriers that make obtaining Skyrizi difficult despite the drug being physically available. These barriers are administrative and financial rather than supply-related.

The primary access challenges include: universal prior authorization requirements (Skyrizi requires PA from virtually every insurer), step therapy policies requiring documented failure of a TNF inhibitor first, specialty-pharmacy-only distribution (not available at any retail pharmacy), and PA renewals required every 6–12 months. First-time PA approval timelines range from 7 to 45 days depending on the insurance plan.

Patients who have prior authorization approved but are struggling to confirm which specialty pharmacy can fill their prescription can use medfinder — a paid service that calls pharmacies on your behalf and texts you which ones can fill your Skyrizi prescription. This saves significant time compared to calling pharmacies individually.

Who Can Prescribe Skyrizi?

Skyrizi is not a controlled substance and carries no DEA scheduling restrictions. Any licensed U.S. healthcare provider can technically prescribe it. However, because Skyrizi requires clinical assessment of disease severity, TB evaluation, prior treatment documentation, and navigation of complex prior authorization requirements, it is almost exclusively prescribed by specialists with experience in biologic therapies.

Specialists who commonly prescribe Skyrizi include:

Dermatologists: Primary prescribers for moderate to severe plaque psoriasis and the dermatologic manifestations of PsA

Rheumatologists: Primary or co-prescribers for psoriatic arthritis patients whose joint disease is the dominant concern

Gastroenterologists: Primary prescribers for Crohn's disease and ulcerative colitis; IBD-specialized gastroenterologists have the most experience managing biologic dosing and monitoring for bowel disease

Nurse Practitioners (NPs) and Physician Assistants (PAs): Can prescribe within their scope of practice when working within a specialty practice setting

Telehealth prescribing is limited for initial Skyrizi starts because in-person TB screening and a physical examination documenting disease severity are typically required before the first prescription. Established patients may continue monitoring and receive PA renewals with telehealth follow-up visits once therapy is initiated in person.

Is Skyrizi a Controlled Substance?

No. Skyrizi (risankizumab-rzaa) is not a controlled substance and has no DEA schedule classification. It can be prescribed by any licensed healthcare provider without the DEA restrictions that apply to scheduled medications (such as narcotics, stimulants, or benzodiazepines). There are no refill limitations based on scheduling, and prescriptions can be transmitted electronically or by phone like any non-controlled medication.

While Skyrizi is not a controlled substance, access is still tightly regulated through insurance prior authorization requirements. The barriers to filling a Skyrizi prescription are almost entirely administrative (insurance PA and step therapy policies) rather than regulatory DEA restrictions. Patients should be aware that insurance authorization—not a pharmacist's decision to dispense—is the primary gating factor for access.

Common Side Effects of Skyrizi

Skyrizi does not carry a FDA Boxed Warning. Common side effects reported in clinical trials include:

Upper respiratory infections (most common — cold, sinus infections, pharyngitis)

Headache (especially during induction)

Arthralgia (joint pain)

Injection site reactions (bruising, redness, pain, swelling, itching)

Tinea infections (ringworm, athlete's foot, jock itch)

Fatigue and low-grade fever (during maintenance, especially in IBD patients)

Serious Side Effects (Seek Medical Attention)

Serious infections including bacterial, viral, or fungal (including TB reactivation — TB screening required before starting)

Serious hypersensitivity reactions / anaphylaxis (contraindicated in patients with prior serious reaction to risankizumab)

Drug-induced liver injury / hepatotoxicity (primarily in IBD patients during induction — monitor LFTs at baseline and during first 12 weeks)

Final Thoughts on Skyrizi

Skyrizi represents a significant advance in biologic therapy for immune-mediated inflammatory diseases. Its selective IL-23 targeting has demonstrated high rates of skin clearance in psoriasis, meaningful improvements in PsA joint outcomes, and durable remission in Crohn's disease and ulcerative colitis. For patients with moderate to severe disease who have not responded to conventional therapies, Skyrizi offers an effective treatment option with a favorable safety profile—no Boxed Warning, relatively low drug interaction potential, and convenient dosing (as infrequently as 4 times per year for psoriasis patients).

The principal challenges with Skyrizi are access-related: the prior authorization process, step therapy requirements, specialty pharmacy distribution, and high list cost without assistance programs. AbbVie's Skyrizi Complete and myAbbVie Assist programs provide robust support for commercially insured and uninsured patients respectively. Providers can significantly improve patient access by enrolling patients in these programs at the time of prescribing and submitting complete PA documentation on the same day.

If you've navigated the insurance process and are ready to fill your Skyrizi prescription, medfinder can help you find which specialty pharmacies near you can fill it. Simply provide your medication, dosage, and location, and medfinder will call pharmacies on your behalf and text you the results.