Diagnosis: Rosacea.
Treatment: Formulary Exception for Soolantra 1% cream.

The insurer denied the Formulary Exception for Soolantra 1% cream. The denial is upheld.

This is a female patient with a diagnosis of rosacea. The patient is noted to have failed topical metronidazole. The patient is not noted to have failed any other topical therapies and is not documented to have a contraindication to other topical therapies. The patient has not failed oral antibiotics, commonly used for the treatment of rosacea. The prescribing provider does not believe that the patient's rosacea, described as "mild-moderate" is sufficient to warrant oral therapy. The requested medication is Soolantra cream.

There are numerous topical therapies, including topical azelaic acid gel and foam as well as sodium sulfacetamide cream, lotion, and wash, which have been shown to successfully treat the signs and symptoms of rosacea, which have not been tried and failed. Similarly, no documentation is provided to indicate that there is any contraindication to the use of these commonly used topical therapies. There is no evidence that Soolantra would have a clinically significantly improved efficacy or side effect profile compared to other topical therapies.

As such, the request for Formulary exception for Soolantra is not supported. The non-formulary drug will not be more effective than the formulary drug.

The insurer's denial of Request for Formulary Exception for Soolantra 1% cream is upheld.