Diagnosis: Psoriasis.
Treatment: Skyrizi Pen.
The insurer denied: Skyrizi Pen.
The denial is: Upheld.

The patient is a male with psoriasis. He has failed clobetasol, halobetasol, and betamethasone. The prescriber is a dermatologist. The medication under review is Skyrizi pen.

The requested health service/treatment of Skyrizi Pen 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 treatments Enbrel, Siliq, and Cosentyx 2 Pack, which have been shown to be effective for psoriasis.
According to the American Academy of Dermatology Psoriasis Guidelines and dermatology literature, the preferred medicines Cosentyx and Enbrel are effective treatments for the management of psoriasis (1, 2). Within the peer-reviewed literature, Garnock-Jones writes "Subcutaneous secukinumab is an effective and generally well tolerated first-line treatment for moderate to severe plaque psoriasis" (3). Moreover, Kivelevitch writes "Anti-tumor necrosis factor (TNF)- agents are currently considered as first line biological therapies for the treatment of moderate to severe psoriasis and psoriatic arthritis" (4).

The evidence-based literature is consistent and in line with the plan's preferred medications. The preferred agents are appropriate agents for the treatment of the patient's psoriasis. These agents should be tried and failed. It is noted that the patient has tried and failed topical therapy. However, after review of the clinical documentation, there is no documentation provided that would justify the patient requiring treatment with Skyrizi prior to the plan preferred alternatives such as Cosentyx and Enbrel.