Diagnosis: Crohn's disease
Treatment: Rinvoq
The insurer denied Rinvoq.
The health plan's determination is overturned.

This patient is a young male with a history of Crohn's disease and atopic dermatitis. He has tried and failed numerous therapies, including Humira and Stelara. He is being considered for bowel resection.

Rinvoq is medically necessary for this patient. The off-label use of this class of medications in refractory cases of inflammatory bowel disease in children is reasonable/appropriate. This patient has a severe and refractory case of inflammatory bowel disease and atopic dermatitis. He has already tried and failed every possible therapy. The use of Rinvoq in this case is reasonable and can help this child avoid bowel resection. Rinvoq is FDA (Food and Drug Administration) approved for atopic dermatitis, which is present in this case.