Diagnosis: Ears/nose /throat/allergy.
Treatment: Pharmacy /prescription drugs.
The insurer denied Azelastine-fluticasone 137-50 MCG/ACT NA SUSP.
The denial is upheld in whole.

This is a young male patient with request for Azelastine-Fluticasone 137-50 MCG/ACT Na Susp for allergic rhinitis. The patient has multiple environmental and food allergies related to pollen allergies. The patient has used Azelastine + Flonase, but the combination spray is being requested to increase the patient's compliance.
No, the formulary alternatives Flunisolide, Fluticasone, Mometasone, or Triamcinolone with Azelastine would not be ineffective for this patient. There are no head to head studies which have shown that the requested non-formulary medication is more effective than the formulary alternatives. The patient has tried Flonase + Azelastine and did well, but the combination spray is being requested to increase the patient's compliance. Therefore, in this case the formulary drugs would be appropriate.