Diagnosis: Parkinson's Disease
Treatment: Formulary exception for Ropinirole Extended Release, Pre-service
The insurer denied the Formulary exception for Ropinirole Extended Release, Pre-service.
The denial is upheld.

The patient is a female with Parkinson's disease (PD). She has been treated with Sinemet. Her provider is now requesting Requip XR (extended release).

No, the health plan should not cover the Formulary exception for Ropinirole Extended Release.

There is no documented reason why the patient cannot be treated with the preferred formulary agents. All of the preferred agents are considered first-line, standard of care treatment options for PD (Parkinson's disease). There are no high-quality clinical trials or standard of care guidelines supporting the preferential use or superiority of Requip XR (extended release) relative to the preferred oral agents.