Diagnosis: Lichen planopilaris
Treatment: Formulary Exception for Tacrolimus Powder Compound
The insurer denied Formulary Exception for Tacrolimus Powder Compound
The denial is overturned

The patient is an adult with a diagnosis of lichen planopilaris (LPP). The patient has significant scalp involvements with scarring alopecia. The request is for topical 0.1% compounded tacrolimus solution. No formulary alternatives were provided by the insurer.

Topical tacrolimus is available as an ointment; however, this product is difficult to apply in the scalp due to its consistency and base. The use of a non-steroidal solution is preferable to systemic therapies as an initial treatment strategy. No Food and Drug Administration (FDA) approved medications are available for the treatment of LPP. The use of compounded tacrolimus 0.1% solution is clinically appropriate for the patient's condition.

Based on the above, the insurer's denial must be overturned. The health care plan did not act reasonably and with sound medical judgment and in the best interest of the patient. The request for Formulary Exception for Tacrolimus Powder Compound is substantiated.