Diagnosis: Eczematous dermatitis and scalp psoriasis

Treatment: Clobetasol foam

The insurer denied coverage for Clobetasol foam. The denial is upheld.

This patient is a male with eczematous dermatitis and scalp psoriasis. For his scalp psoriasis he was given samples of blue foam and loprox shampoo and he was given nizoral shampoo and Clobetasol foam. Formulary exception for Clobetasol has been requested.

Per Schlager, J. G., et al. (2016), "The two-compound combination as well as corticosteroid monotherapy were more effective and safer than vitamin D monotherapy. Given the similar safety profile and only slim benefit of the two-compound combination over the steroid alone, monotherapy with generic topical steroids may be fully acceptable for short-term therapy."

Per Wang, T. S., & Tsai, T. F. (2017), "Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol-betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis."

Per Svendsen, M. T., Feldman, S. R., Tiedemann, S. N., Sørensen, A., Rivas, C., & Andersen, K. E. (2019), "Four surveys, six randomized controlled trials, and two prospective studies of mainly good quality were included. Seven of the studies investigated patient preferences for topical drug formulations, while five studies investigated their preferences for different topical drugs. Overall, patients preferred drugs that are easy to apply, less messy, and have a pleasant scent."

There is no documentation that the patient has attempted therapy with any of the formulary medications. There is no documentation of an allergy or contraindication to the formulary drugs listed. The requested medication is not more effective than the formulary drug.

The patient has involvement of his scalp, making creams and ointments impractical, but the formulary medications fluocinolone and fluocinonide come in solutions which are practical and effective for treatment of the hair bearing scalp. Thus formulary exception is not necessary.

The insurer's denial of Formulary exception for Clobetasol foam is upheld.