Diagnosis: Rhinitis, difficulty swallowing.
treatment: Dexlansoprazole 60 mg Capsule.
The insurer denied Dexlansoprazole 60 mg Capsule.
The health plan's determination is overturned.

The patient is woman with a history of gastroesophageal reflux disease causing secondary heartburn, laryngopharyngeal reflux, and laryngeal edema. A fiberoptic endoscopic evaluation of swallowing test showed active reflux despite high dose Omeprazole 40 milligrams (mg) daily. She has undergone an upper gastrointestinal endoscopy evaluation which did not reveal any additional causes to account for the patient's symptoms. She has been prescribed a variety of H2- (histamine 2) Blockers and Proton Pump inhibitors including Prevacid, Pantoprazole, Famotidine, and Omeprazole with persistent breakthrough symptoms.

A formulary exception is indicated in this case.
The patient has been prescribed a variety of H2-Blockers and Proton Pump inhibitors in the past including Prevacid, Pantoprazole, Famotidine, and Omeprazole with persistent breakthrough symptoms. Approximately 1 year earlier, she was prescribed Dexlansoprazole 60 mg daily with significant improvement in symptoms. Thus, prior trials of formulary drugs have been ineffective.