Diagnosis: Skin Disorders/Rosacea
Treatment: Opzelura 1.5% EX CREA (external cream)
The health plan denied the Opzelura 1.5% EX CREA.
The health plan's determination is upheld.

The patient is a male with rosacea. He has tried and failed Metronidazole Gel, Azelaic Acid Gel, and Doxycycline. He has also failed Tacrolimus ointment. The medication under review is Opzelura.
At issue is the medical necessity for the requested medication, Opzelura.

The health plan's determination of medical necessity is upheld, in whole.

The requested health service/treatment of Opzelura is not medically necessary for this patient. There is no documentation provided that the patient has tried and failed Eucrisa ointment. There is no documentation provided that the patient has tried and failed the standard of care treatment Sodium Sulfacetamide wash.
According to the dermatology literature, Sulfacetamide Sulfur topicals are effective treatments for the management of rosacea. [1-3]
Two et al writes in the Journal of the American Academy of Dermatology, "Rosacea: Part II. Topical and systemic therapies in the treatment of rosacea," that "Topical treatments approved by the US Food and Drug Administration for rosacea include topical Sodium Sulfacetamide..." [4]
Abokwidir writes, "Topical Sodium Sulfacetamide, 10% Sodium Sulfacetamide with 5% sulfur, is useful in treating patients with rosacea."[5]
The evidence-based literature is consistent and in line with the patient's medical policy. The preferred agents are appropriate agents for the treatment of the patient's rosacea. The formulary medications should be tried and failed prior to initiating Opzelura.