Diagnosis: Gout

Treatment: Formulary Exception for Indomethacin 50mg capsule

The insurer denied coverage for Formulary Exception for Indomethacin 50mg capsule. The denial is overturned.

This patient is a male with a history of gout. His internist is requesting authorization for indomethacin. In an appeal the doctor notes that the patient has been successfully treated with indomethacin and is currently having a flare. He has tried and failed Naproxen as well as Sulindac 200 mg BID (twice daily). As discussed in www.uptodate.com "Treatment of Gout Flares," non-steroidal anti-inflammatory drugs (NSAIDS) such as indomethacin, sulindac and naproxen are effective treatments for gout. There are many NSAIDs, and many have shown efficacy in gout (although no one of them is universally effective). In this case, the treating medical doctor (MD) has noted that the patient has previously failed naproxen and Sulindac.

While the formulary drug(s) is not likely to cause the patient an adverse reaction, the formulary options have been ineffective. The patient has tried and failed treatment with insurer's formulary drugs and has had success with the requested drug, indomethacin.

The requested drug has been more effective that the formulary options. He is currently having a flare and this is his best most effective option.

The carrier's denial of Request for Formulary Exception for Indomethacin 50mg capsule is overturned.