Tammy is a 55-year-old female who suffers from psoriatic arthropathy (L40.59) and plaque psoriasis (L40.0). Tammy’s symptoms include painful joints, red, scaly, itchy plaques located on her upper extremities. Tammy has tried and failed various treatments including Enbrel, methotrexate, dovonex, otezla, codeine, Vicodin, and Indocin, which inadequately controlled her symptoms. The denial states coverage of Stelara requires starting at 45mg. The recommended dose for patients weighing over 100 kg’s is 90 mg initially, and 4 weeks later, followed by 90 mg every 12 weeks. Tammy’s weight is over 200 pounds, which she clearly meets the recommended dosing set forth by the manufacture. Stelara is Tammy’s best treatment option at this time. Without
