top of page
< Back

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.

bottom of page