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201912-123802
2020
Healthfirst Inc.
Medicaid
Skin Disorders
Pharmacy/ Prescription Drugs
Medical necessity
Upheld
Case Summary
Diagnosis: Psoriasis
Treatment: Taltz
The treatment with Taltz is not medically necessary.
The patient is a male with psoriasis, treated with topicals and Stelara. The provider wants to switch the patient to Taltz after failure of Stelara.
Taltz is not approved in patients under age 18, and there is insufficient evidence in current peer-reviewed literature to support its use in adolescents. The request is therefore not medically necessary. No literature was found studying Taltz in patients under age 18.
Enbrel is a treatment that has been used in children with psoriasis.
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