How to Renew Skyrizi (Risankizumab) Coverage with Humana in Georgia: 2025 Timeline and Appeals Guide
Answer Box: Skyrizi Renewal with Humana in Georgia
Skyrizi (risankizumab) renewal with Humana requires updated clinical documentation submitted before your current authorization expires—typically every 12 months. Start the renewal process 60-90 days early to avoid therapy gaps. If denied, you have 60 days to appeal through Humana's internal process, then external review through Georgia's Department of Insurance within 60 days of final denial. First step today: Check your current authorization expiration date by calling Humana at 1-800-HUMANA or logging into your member portal.
Table of Contents
- Renewal Triggers: When to Start Early
- Evidence Update: What Documentation You Need
- Renewal Packet: Must-Include Documents
- Timeline: Submission Deadlines and Decision Windows
- If Coverage Lapses: Bridge Options and Emergency Fills
- Annual Changes: Formulary Updates to Monitor
- Appeals Process: Internal and External Review in Georgia
- Personal Tracker: Renewal Progress Template
- FAQ: Common Renewal Questions
Renewal Triggers: When to Start Early
Your Skyrizi authorization doesn't automatically renew. Most Humana Medicare Advantage plans require renewal every 12 months, though some conditions may have shorter authorization periods. Here are the key triggers to watch for:
Timeline Warning Signs
- 60-90 days before expiration: Ideal time to begin renewal process
- 30 days before expiration: Last chance to avoid potential therapy gaps
- Formulary change notifications: Humana must provide 30 days' notice if Skyrizi's coverage status changes
Early Renewal Indicators
Start your renewal process early if you experience:
- New or worsening side effects requiring documentation
- Changes in your condition severity
- Recent hospitalizations or emergency visits
- Lab value changes that affect treatment monitoring
Note: Skyrizi IV was removed from some Humana preferred drug lists in 2025, making early renewal planning even more critical for affected patients.
Evidence Update: What Documentation You Need
Humana requires objective evidence that Skyrizi continues to be medically necessary and effective for your condition. The specific documentation varies by indication:
For Plaque Psoriasis
- PASI Score: Updated Psoriasis Area and Severity Index showing improvement (typically PASI 75 or better response)
- Photographic documentation: Before/after images if available
- Quality of life assessments: Dermatology Life Quality Index (DLQI) scores
For Psoriatic Arthritis
- Joint assessment: Updated joint counts and disease activity measures
- Functional status: Health Assessment Questionnaire (HAQ) or similar tools
- Imaging results: X-rays or MRIs showing disease progression or stability
For Crohn's Disease/Ulcerative Colitis
- Endoscopic findings: Recent colonoscopy or sigmoidoscopy results
- Clinical indices: CDAI (Crohn's Disease Activity Index) or Mayo Score
- Laboratory values: CRP, ESR, fecal calprotectin levels
Universal Requirements
All renewals need:
- Liver function tests: ALT, AST, and bilirubin levels (baseline and ongoing monitoring)
- Infection screening: Updated TB screening if clinically indicated
- Adherence documentation: Pharmacy fill history and patient-reported compliance
Renewal Packet: Must-Include Documents
Your renewal submission should include these core components:
Patient Information
- Current insurance card and member ID
- Complete contact information and preferred communication method
- List of current medications and dosages
Clinical Documentation
- Provider attestation form: Completed by your prescribing physician
- Updated medical records: Recent office visit notes (within 3-6 months)
- Laboratory results: Current values for required monitoring parameters
- Response documentation: Objective measures showing treatment effectiveness
Prior Authorization History
- Copy of current/expiring authorization
- Documentation of any previous step therapy requirements met
- Records of prior medication failures or intolerances
Tip: Counterforce Health specializes in helping patients and providers compile comprehensive renewal packets that address payer-specific requirements and reduce the likelihood of denials.
Timeline: Submission Deadlines and Decision Windows
Understanding Humana's processing timelines helps you plan effectively:
Standard Timeline
| Phase | Timeline | Your Action |
|---|---|---|
| Renewal Submission | 60-90 days before expiration | Submit complete packet |
| Initial Review | 14-30 days | Monitor for requests for additional information |
| Decision Notification | Within 30 days of submission | Review approval letter or denial |
| Appeal Window | 60 days from denial | File internal appeal if denied |
Expedited Process
If your medical situation is urgent, you can request expedited review:
- Standard expedited: Decision within 72 hours
- Emergency situations: Decision within 24 hours
- Requirements: Physician documentation of medical urgency
Key Deadlines for Georgia Residents
- Internal appeal: Must be filed within 60 days of denial
- External review: Must be requested within 60 days of final internal denial
- Transition supply: Up to 31 days if coverage changes occur
If Coverage Lapses: Bridge Options and Emergency Fills
If your Skyrizi authorization expires before renewal approval, several options may help maintain therapy:
Emergency Fill Options
- Transition supply: Humana may provide up to 31 days of medication during coverage transitions
- Emergency fills: Available during natural disasters or urgent medical situations
- Appeal pending supply: Temporary coverage while appeals are processed
Bridge Therapy Considerations
Important: With Medicare's 2025 out-of-pocket cap of $2,000, most patients will have significantly reduced costs once the threshold is reached. This makes temporary gaps less financially burdensome than in previous years.
Manufacturer Support
- Skyrizi Complete: AbbVie's patient support program may offer temporary assistance
- Copay cards: Available for eligible patients (restrictions apply to government insurance)
- Patient assistance programs: Income-based support for qualifying individuals
Contact Information for Emergency Situations
- Humana Customer Service: 1-800-HUMANA (1-800-486-2620)
- Humana Specialty Pharmacy: Available through member portal
- Georgia Department of Insurance: 1-800-656-2298 for consumer assistance
Annual Changes: Formulary Updates to Monitor
Humana updates its drug formularies annually, with potential mid-year changes. Stay informed about:
2025 Formulary Changes
Skyrizi's formulary status may change, affecting:
- Tier placement: Higher tiers mean increased out-of-pocket costs
- Prior authorization requirements: New restrictions may be added
- Quantity limits: Dosing restrictions may be implemented
- Step therapy: Additional medications may need to be tried first
Monitoring Resources
- Humana formulary updates: humana.com/medicaredruglist
- Provider notifications: Watch for updates from your prescriber's office
- Member communications: Review all mail and electronic notifications from Humana
Exception Process
If formulary changes negatively impact your Skyrizi coverage:
- Request formulary exception within 30 days of notification
- Provide medical necessity documentation from your physician
- Continue current therapy during the exception review process
Appeals Process: Internal and External Review in Georgia
If your Skyrizi renewal is denied, Georgia residents have robust appeal rights:
Internal Appeal (First Level)
Timeline: File within 60 days of denial Process:
- Call Humana at the number on your denial letter
- Submit written appeal with supporting documentation
- Request expedited review if medically urgent
- Receive decision within 30 days (72 hours if expedited)
External Review (Second Level)
If internal appeal fails, Georgia law provides external review through the Georgia Department of Insurance:
Eligibility: Denials based on medical necessity, experimental treatment, or similar utilization review decisions Timeline: Must request within 60 days of final internal denial Cost: Free to consumers Process:
- Submit application to Georgia DOI
- Independent physicians review your case
- Decision within 30 business days (72 hours if expedited)
- Final decision is binding on Humana
Required Documentation for Appeals
- Copy of original denial letter
- All medical records supporting medical necessity
- Physician statement explaining why Skyrizi is appropriate
- Documentation of failed alternative therapies
- Any relevant clinical guidelines or studies
From our advocates: We've seen successful appeals where patients provided comprehensive documentation showing not just current disease activity, but also the progression that led to Skyrizi therapy and the objective improvements achieved. The key is painting a complete clinical picture that demonstrates ongoing medical necessity.
Personal Tracker: Renewal Progress Template
Use this template to track your renewal progress:
Important Dates
- Current authorization expires: ___________
- Renewal submission target: ___________ (60-90 days before expiration)
- Provider appointment scheduled: ___________
- Lab work completed: ___________
Documentation Checklist
- Updated disease activity scores (PASI/joint counts/endoscopy)
- Recent lab results (liver function, inflammatory markers)
- Provider attestation form completed
- Pharmacy fill history obtained
- Previous authorization documents gathered
Submission Tracking
- Renewal submitted: ___________
- Confirmation received: ___________
- Additional information requested: ___________
- Decision received: ___________
- Appeal filed (if needed): ___________
FAQ: Common Renewal Questions
How long does Humana take to process Skyrizi renewals? Standard processing takes 14-30 days. Expedited reviews are completed within 72 hours if medical urgency is documented.
What if my doctor is too busy to complete the renewal forms? Contact your provider's office early and ask about their preferred timeline for prior authorization requests. Many offices batch these requests on specific days.
Can I continue Skyrizi if it's removed from Humana's formulary? Yes, through the formulary exception process. Your physician must provide medical necessity documentation explaining why covered alternatives aren't appropriate.
What happens if I miss the renewal deadline? Contact Humana immediately to request a retroactive authorization or emergency fill. Document any therapy interruption and its impact on your condition.
Does step therapy apply to renewals? Generally no, if you're already established on Skyrizi. However, formulary changes may trigger new step therapy requirements, which can be appealed.
How does the Medicare $2,000 out-of-pocket cap affect Skyrizi costs? Once you reach $2,000 in Part D drug costs in 2025, all covered medications including Skyrizi are provided at no additional cost for the remainder of the year.
When Treatment Authorization Becomes Complex
Counterforce Health helps patients, clinicians, and specialty pharmacies navigate complex prior authorization and renewal processes. Their platform analyzes denial patterns, identifies the specific evidence payers require, and creates targeted appeals that address plan-specific requirements. For Skyrizi renewals with Humana, this can mean the difference between a smooth approval and a lengthy appeals process.
Sources & Further Reading
- Humana Medicare Prescription Drug Guide 2025
- Humana Prior Authorization Lists
- Georgia Department of Insurance Consumer Services
- Medicare Part D Appeals Process
- Skyrizi Prescribing Information
Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Always consult with your healthcare provider regarding your specific medical condition and treatment options. For insurance-specific questions, contact Humana directly or consult with a qualified insurance professional. Coverage policies and procedures may change; verify current requirements with your plan.
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