Diagnosis: Tinea Unguium
Treatment: Formulary exception for Jublia
The insurer denied the Formulary exception for Jublia
The denial is overturned

The patient is a male. He suffers from onychomycosis and has undergone treatment with various topical agents without success. This included clotrimazole, in line, as well as several other antifungals including ketoconazole. He was then prescribed and efinocozole which he began using and saw improvement in his onychomycosis. He has confirmed onychomycosis by biopsy.

Yes, the health plan should cover the Formulary exception for Jublia.
The health plan should cover the Formulary exception for Jublia, as it has already been effective for the patient. It does meet FDA (United States Food and Drug Administration) guidelines for use and he has tried all the alternative topical medications. Alternative to medical treatment is laser therapy, which is not covered by insurance. The formulary drugs have not been effective for the patient, as he has already tried and failed them. Multiple high-level clinical trials have shown success in the treatment of onychomycosis (1, 2).