Diagnosis: IBS (irritable bowel syndrome) and constipation.
Treatment: Formulary exception for Chlordiazepoxide-Clidinium.

The insurer denied the Formulary exception for Chlordiazepoxide-Clidinium. The denial is overturned.

Yes, the health plan should cover the Formulary exception for Chlordiazepoxide-Clidinium.

The patient is a female with IBS (irritable bowel syndrome) and constipation. She has failed treatment with Bentyl (dicyclomine), as well as Cipro and Flagyl.

In order for criteria for Chlordiazepoxide-Clidinium to be met for the treatment of IBS, the patient must have failed the preferred formulary alternative dicyclomine. The patient has failed treatment with Bentyl (dicyclomine), as well as Cipro and Flagyl.

Chlordiazepoxide-Clidinium is a safe an effective treatment for IBS. The patient has failed the health plan's formulary alternative of dicyclomine. Therefore, the health plan should cover the Formulary exception for Chlordiazepoxide-Clidinium.