Diagnosis: Multiple Myeloma
Treatment: Velcade 3.5 milligrams Intravenously Twice Weekly, 2 weeks on and 1 Week Off Every Three Weeks (1.77 mg per square meter)
The insurer denied the Velcade 3.5 milligrams Intravenously Twice Weekly, 2 weeks on and 1 Week Off Every Three Weeks (1.77 mg per square meter).
The denial is upheld.

The patient in this case is a woman diagnosed with multiple myeloma. Treatment with Velcade 3.5mg (milligrams) (1.77mg/m2 [milligrams per meters squared]) given twice weekly, two weeks on and one week off on a 21 day cycle has been prescribed. Records indicate that this patient has been on treatment with Velcade, though do not specify dose.

No, the requested Velcade is not medically necessary.
Velcade at a dose of 1.77mg/m2 (milligrams per meters squared) given twice weekly is not a standard treatment for multiple myeloma. There is no evidence showing that this treatment is safe and effective for treatment of multiple myeloma and it is not an accepted standard means of giving this agent. While Velcade is a standard drug for treatment of multiple myeloma, the dose and schedule being prescribed is not standard of care and is not medically necessary.

Yes, the health plan did act reasonably, with sound medical judgment, and in the best interest of the patient.