Diagnosis: Hypothyroidism

Treatment: Armour Thyroid 120 mg OR tabs

The insurer denied coverage for a formulary exception for Armour Thyroid 120 mg OR tabs. The denial was upheld.

This case involves a female patient with a diagnosis of hypothyroidism, unspecified. There was documentation that the patient was prescribed Synthroid for 4 years. The patient was then switched to Armour Thyroid 90 mg and 3 years later the Armour Thyroid was increased to 120 mg. The rationale for the change from the formulary medication, Synthroid to a non-formulary medication, Armour Thyroid was not noted.

Medical literature states that synthetic thyroid medications are efficacious in achieving symptom improvement with normalization of thyroid function in the vast majority of patients. They are well tolerated, have a favorable side-effect profile, good intestinal absorption. However, there is a significant minority of patients that may experience intolerance, allergy or adverse reactions to inactive ingredients used in the synthetic formulations.

The clinical records submitted for review fail to provide a rationale for the change from a formulary medication, Synthroid to a non-formulary medication, Armour Thyroid. There was no documentation of an adverse reaction to Synthroid, or documentation that the Synthroid was ineffective and there was no documentation that Armour Thyroid is more effective than the formulary drug, Synthroid.

The carrier's denial of Formulary Exception for Armour Thyroid 120 mg OR TABS is upheld.