Diagnosis: Psoriasis, Psoriasis Arthritis

Treatment: Taltz

The insurer denied the Taltz. The denial was reversed.
This is a male patient with a history of psoriasis and psoriasis arthritis that involves more than 5% of his body surface area; his truck, left leg, and neck. It was reported that the patient has been treated and has failed topical steroid medications, narrow band ultraviolet light therapy, as well as oral medication such as Stelara, Enbrel, Otezla. He is currently being treated with Cosentyx. His dermatologist is requesting Taltz.
Leonardi C1, Maari C2, Philipp S3, Goldblum O4, Zhang L4, Burkhardt N4, Ball S4, Mallbris L4, Gonzalez P5, Fernández-Peñas P6, Puig L7. (2018), "At week 156, 80.5% of patients had achieved at least a 75% improvement from baseline in their Psoriasis Area Severity Index (PASI) score, 66.0% had achived at least a 90% improvement from baseline in their PASI score, and 45.1% had achieved a 100% improvement from baseline in their PASI score with use of the modified nonresponder imputation method, and 97.2% and 86.2% of patients had achived at least a 75% improvement from baseline in their PASI score with use of the as-observed and multiple imputation methods, respectively. Similar response rates were observed in patients with baseline scalp, nail, or palmoplantar involvement. No new safety signals were identified through year 3."

Genovese, M. C., Combe, B., Kremer, J. M., Tsai, T. F., Behrens, F., Adams, D. H., Nash, P. (2018), "During the extension period, the overall safety profile of ixekizumab remained consistent with that observed with the double-blind period, and clinical improvements persisted up to 1 year."

Gottlieb AB. et al. (2018), "Improvements from baseline in PASI 75, PASI 90, and PASI 100 were observed in both groups with and without PsA involvement (Fig 1)."
The health care plan did not act reasonably and with sound medical judgment and in the best interest of the patient. The patient has tried and failed biologics (Stelara, Enbrel and Cosentyx), methotrexate will be inappropriate. The patient has a diagnosis of psoriatic arthritis Tremfya, and skyrizi are inappropriate for this patient. The patient has tried and failed an anti-TNF, Cimzia and Humira are inappropriate.

Based on the above, the medical necessity for Taltz is substantiated. The insurer's denial is reversed.