Randall is a 58-year-old male who suffers from long history plaque psoriasis (L40.0). Randall’s symptoms include dry, itchy, red, thick, and moderate in severity plaques throughout his body, with a BSA of 70%. Patient has tried and failed various treatments including ensilar, triamcinolone, hydrocortisone, ketoconazole, kenalog, and humira, with little to no relief. The denial states that Randall must have a history of failure, contraindication, or intolerance to Enbrel. Enbrel suppress the immune system and carries warnings for an increased risk of serious infections and malignancies. Randall has been on Humira with not much improvement. Having Randall try Enbrel would be unethical when Enbrel is in the same drug class as Humira, in
