Diagnosis: Acne
Treatment: Formulary exception for Winlevi 1% Cream
The health plan denied Winlevi 1% Cream.
The denial is upheld.

The patient is an adult male with acne, treated with clindamycin and benzoyl peroxide. The provider is requesting Winlevi cream. The health plan requires use of three or more formulary agents such as adapalene, benzoyl peroxide, clindamycin, erythromycin, Tretinoin and tazarotene.

The formulary alternatives are: adapalene cream/gel; adapalene-benzoyl peroxide gel; benzoyl peroxide; clindamycin gel/lotion/solution/foam; clindamycin-benzoyl peroxide gel; erythromycin gel/solution erythromycin-benzoyl peroxide gel; sulfacetamide sodium lotion 10%© (copyright); tazarotene cream/gel; tretinoin cream/gel.

The formulary medications would also be effective for this patient, and would have similar possible adverse effects such as dryness and irritation. The formulary agents are also appropriate for this patient.