Diagnosis: Sexual dysfunction, vaginal atrophy, uterine prolapse

Treatment Estring

The insurer denied coverage for Estring

The denial is overturned

The patient is a female with a past history of sexual dysfunction, vaginal atrophy, uterine prolapse, chronic interstitial cystitis status post hysterectomy, and bilateral salpingo-oophorectomy. The provider noted that the patient had tried and failed Estrace cream and estradiol cream which produced burning, pruritus, and rash. The Femring gave an inadequate response. The patient had a trial and failure of a generic agent. The provider requested Estring 2 milligram (mg).

The provider appeal letter noted that the patient had been using the medication for years and it was effective.

The patient has had an adverse reaction to previously tried formulations, Estradiol cream, and brand Estrace cream.

The patient has tried and failed Estradiol cream, and brand Estrace cream due to side effects as well as Femring which was ineffective.

The requested Estring has been shown to be more effective than the previously 3 tried and failed medications. The patient has successfully used Estring for years, with noted efficacy and without adverse effects.

The insurer's denial of coverage for Formulary Exception for Estring is reversed.