Diagnosis: Skin disorders /psoriasis
Treatment:Pharmacy/prescription drugs
The insurer denied Humira
The denial is upheld in whole

The patient with moderate to severe psoriasis vulgaris, which includes the groin and rectal region, and causes pain during urination and bowel movements, and interferes with performing daily routines. The patient has tried and failed topical fluocinonide, calcitriol (Vectical), Cutivate, and Fluticasone. No psoriatic arthritis was noted.
No, the requested Humira is not medically necessary for this patient.
The patient has no documented treatment failure with, or true medical contraindication, to standard, first-line systemic therapies such as either Methotrexate or Acitretin. Modern dermatology literature [1-4] supports the use of preferred medications as similarly efficacious to the requested Humira, particularly for a patient with a limited history of systemic psoriasis therapy previously utilized, and recommend use of these preferred agents as appropriate for this patient's clinical scenario. Therefore, consistent with modern dermatology literature [1-4] and as per current medical standards of care, Humira is not medically necessary.