Diagnosis: Skin Disorders.
Treatment: Pharmacy/Prescription Drugs.
The insurer denied Taltz.
The denial is upheld.

The patient is a female with psoriasis and psoriatic arthritis. She has axial involvement. She has failed clobetasol ointment, and naproxen. The subject under review is the medical necessity for Taltz.

Taltz is not medically necessary for this patient. There is no documentation provided that the patient has tried and failed, has a contraindication to, or intolerance to the preferred alternatives Enbrel, Humira, Renflexis, Inflectra or Avsola.
According to the American Academy of Dermatology Psoriasis Guidelines and medical literature, the preferred medicines such as Humira and Enbrel covered by the health plan are effective treatments for the management of psoriasis and psoriatic arthritis (1, 2). Within the peer-reviewed literature, according to Burness et al., "well-designed randomized clinical trials demonstrated that adalimumab 40 milligrams (mg) every other week (eow) effectively reduced the signs and symptoms of psoriasis and improved dermatology-specific and general measures of health-related quality of life, with these benefits sustained during long-term treatment" (3). Mease et al. writes "Adalimumab significantly improved joint and skin manifestations, inhibited structural changes on radiographs, lessened disability due to joint damage, and improved quality of life in patients with moderately to severely active psoriatic arthritis (PsA)" (4). The plan preferred agents are appropriate agents for the treatment of the patient's psoriasis and psoriatic arthritis.