Rosendo Case Study

Rosendo is a 32-year-old male who suffers from chronic plaque psoriasis (L40.0), along with psoriatic arthritis. His symptoms include dry, itchy, scaly, large, thick patches of plaques, located on his arms, back, legs, scalp, and behind his ears, as well as experiencing tenderness in the knees and fingers. Rosendo has tried and failed various treatments including triamcinolone, which provided little to no relief. Cosentyx was denied stating that the records sent do not show that he has tried another medication like Methotrexate, Cyclosporine or Acitretin. He is not a candidate for Methotrexate, Acitretin, and Cyclosporine as they have Black Box warnings due to the dangerousness of the side effects causes by these specific treatments, in addition

these medications can cause serious problems with pregnancy and are not advised for patients; male or female, who could parent a child, additionally, the requirement trial of light therapy, PUVA and UVB, due to Rosendo’s time, travel constraints, light therapy is not an option. Rosendo’s symptoms have the capability of becoming quite debilitating and are already impacting his quality of life and daily functions. Cosentyx is the only biologic that can be used as first-line systemic therapy in the treatment of psoriasis and as an alternative to treatments that have significant side effects. Cosentyx works differently by binding to and inhibiting a cytokine (chemical messenger) called interleukin-17A (IL-17A), which is involved in inflammatory and immune responses. There are elevated levels of IL-17A in psoriatic plaques. By inhibiting cytokines that trigger inflammation, Cosentyx interrupts the inflammatory cycle of psoriasis and which can lead to the improvement in symptoms for many people who take it. Cosentyx is his best treatment option now, therefore I am requesting an exception that Cosentyx be covered for Rosendo, or else, I fear his condition will worsen, causing increased pain, suffering, and embarrassment, along with the significant reduction in quality of life and psychosocial disability, as he has unbearable, unendurable, oppressive symptoms which are getting worse, and are an enormous impingement on his quality of life.