Diagnosis: Psoriatic Arthritis.
Treatment: Taltz.

The insurer denied the Taltz.

The determination is upheld.

The patient has a history of psoriatic arthritis and uveitis. Taltz is being denied by the health plan. The reason cited is she has not tried and failed Cosentyx, the preferred alternative drug. Prior treatment included Otezla and Enbrel. At issue is the medical necessity of Taltz.

The requested health service/treatment of Taltz is not medically necessary for this patient. There is no medical reason that the patient cannot try the formulary alternative, Cosentyx. She does not have a contraindication to Cosentyx and it is equivalent as far as efficacy, mechanism of action and side effects to Taltz. The preferred drug on the formulary is Cosentyx, another interleukin (IL) -17 antagonist that is very similar to Taltz.
In an article published in the New England Journal of Medicine, it was found that 'secukinumab was more effective than placebo in patients with psoriatic arthritis, which validates interleukin-17A as a therapeutic target'. Cosentyx (secukinumab) is the formulary drug. There is no data showing that Taltz is superior to Cosentyx for the treatment of psoriatic arthritis (PsA) and uveitis. There is no medical reason or contraindication to why the patient cannot try Cosentyx instead of Taltz.