Leqselvi (deuruxolitinib tablets) — Cigna

Alopecia areata (including alopecia totalis and alopecia universalis)

Initial criteria

Patient age ≥ 18 years; AND
Patient is not a cytochrome P450 2C9 poor metabolizer as assessed by an approved test; AND
Patient has a current episode of alopecia areata lasting for ≥ 6 months; AND
Patient has ≥ 50% scalp hair loss; AND
Patient has tried at least ONE of the following for alopecia areata (a or b):
a) Conventional systemic therapy; OR
b) High- or super-high potency topical corticosteroid; AND
An exception to the requirement for a trial of one conventional systemic agent can be made if the patient has already tried Litfulo (ritlecitinib capsules) or Olumiant (baricitinib tablets); AND
Medication is prescribed by or in consultation with a dermatologist.

Patient age ≥ 18 years; AND
Patient has been established on Leqselvi for at least 6 months; AND
Patient experienced a beneficial clinical response, defined as improvement from baseline in extent and density of scalp hair loss; AND
According to the prescriber, the patient continues to require systemic therapy for treatment of alopecia areata.

initial: 6 months; reauth: 1 year