Litfulo (ritlecitinib capsules – Pfizer) — Cigna

Initial criteria

• Patient is age ≥ 12 years; 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 Leqselvi (deuruxolitinib tablets) or Olumiant (baricitinib tablets); AND
• Medication is prescribed by or in consultation with a dermatologist

Reauthorization criteria

• Patient is age ≥ 12 years; AND
• Patient has been established on Litfulo 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

Approval duration

initial 6 months; reauth 1 year