Diagnosis: Restless Leg Syndrome.
Treatment: Formulary exception for Ropinirole ER 2mg Tablet, Pre-service.
The insurer denied the Formulary exception for Ropinirole ER 2mg Tablet, Pre-service. The denial is upheld.

The patient is a male with restless leg syndrome (RLS). He has tried and failed Horizant and gabapentin. The provider is requesting ropinirole ER (extended release) noting improvement with treatment.

No, the health plan should not cover the Formulary exception for Ropinirole extended release.

There is no documented reason the patient cannot be treated with the preferred ropinirole immediate release. The preferred medication has the same exact mechanism of action and is FDA (United States Food and Drug Administration)-indicated for the treatment of RLS (restless leg syndrome) (Winkelmann et al.). There are no clinical trials or standard of care guidelines to support the superiority or preferential use of ropinirole ER (extended release) relative to ropinirole IR (immediate release) for this patient's condition.