Diagnosis: Irritable bowel syndrome.
Treatment: Chlordiazepoxide-Clidinium.

The insurer denied the Chlordiazepoxide-Clidinium.
The denial is upheld.

The patient is a male with irritable bowel syndrome (IBS). His medical doctor (MD) is requesting treatment with chlordiazepoxide-clidinium.

No, the health plan should not cover the proposed treatment.

While Chlordiazepoxide-clidinium is clinically appropriate and accepted standard of care for the treatment of irritable bowel syndrome (IBS), as there is no medical literature to support that it is more effective or safer than the preferred formulary alternatives dicyclomine or hyoscyamine, it should not be covered by the health plan. There is no documentation that the patient has failed the preferred dicyclomine or hyoscyamine, and no evidence that the patient would suffer adverse effects from dicyclomine or hyoscyamine, or that Chlordiazepoxide-Clidinium is more effective than dicyclomine or hyoscyamine to treat irritable bowel syndrome.