Skin Disorder
Pharmacy/prescription drugs

Diagnosis: Rosacea
Treatment: Soolantra
The insurer denied Soolantra.
The health plan's determination is upheld.

The patient is a female with rosacea, for which Soolantra 1% cream is under review for medical necessity. Doxycycline (50 mg/day) has been prescribed and utilized but was not utilized for a 12-week consecutive trial as per the history. Topical Metrogel has been prescribed and filled. The use of Soolantra is under review for medical necessity.

Soolantra Cream is not medically necessary for this patient.

The patient has no documented treatment failure with, or true medical contraindication to, standard, first-line topical therapies (such as sustained topical Metrogel, Finacea, or Permethrin) or systemic therapies such as either Minocycline or Doxycycline. Furthermore, Doxycycline previously utilized was at a low dose (50 mg/day) that would not be anticipated to benefit this patient. Therefore, consistent with current literature and standards of care, the requested 1% Soolantra cream is not medically necessary.