Diagnosis: Skin Disorders (psoriasis).
Treatment: Pharmacy/Prescription Drugs.

The insurer denied Taltz. The denial is upheld in whole.

The patient is a female with psoriasis and has tried and failed topical triamcinolone and oral Keflex. The patient tried cyclosporine but discontinued it because of jittery/anxiety symptoms. Prednisone was ineffective. Alcohol consumption has precluded use of Methotrexate (the clinic records report less than one alcoholic beverage consumed per day).

Health plan coverage of Taltz is under review.

The health plan's determination is upheld in whole.

No, the formulary alternative drug would not be ineffective. Modern dermatology literature [1-4] supports use of the health plan preferred medications as similarly efficacious to the requested Taltz, 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. The patient has not utilized long-term and adherent trials of first-line psoriasis systemic therapies. Furthermore, the options of Humira, Skyrizi, Tremfya, Enbrel, Cosentyx, or Cimzia are all appropriate and likely to be effective for use in a patient with no past history of biologic therapy. Therefore, Taltz would not be more effective than the formulary alternatives.