Diagnosis: Chronic Constipation.
Treatment: Trulance.

The insurer denied coverage for Trulance.

The denial is overturned.

The patient has abdominal pain and constipation. She had previous surgery for endometriosis and is felt to have adhesions. She had initially responded to Motegrity, but it was no longer effective. She has been using Lactulose. A letter from her physician states that she has also been treated with Linzess.

UpToDate has an article titled "Management of chronic constipation in adults." The article discusses pharmacological therapy. Linaclotide, Plecanatide, Lubiprostone, and Prucalopride are all Food and Drug Administration (FDA) approved treatments for chronic constipation. The safety and efficacy of Plecanatide has been studied. It has been shown to be superior to placebo in clinical trials and results in improvement in frequency of complete spontaneous bowel movements.

This patient has chronic constipation. She has already tried and failed multiple formulary medications including Linzess, magnesium citrate, and Miralax. She has now also failed to respond to Motegrity. Under these circumstances giving the patient Plecanatide (Trulance) is appropriate. The formulary alternatives are not likely to cause the patient an adverse reaction. However, the formulary drugs have been ineffective according to the physician's letter. Since there are alternatives to the formulary drugs that have not yet been tried, such as Trulance, it is hopeful that it will be effective.

The insurer's denial of coverage for Formulary Trulance is overturned.