Olumiant (baricitinib tablets – Lilly) — Cigna

Initial criteria

• Patient age ≥ 18 years
• Current episode of alopecia areata lasting ≥ 6 months
• ≥ 50% scalp hair loss
• Tried at least ONE of the following for alopecia areata (a or b): (a) Conventional systemic therapy (e.g., corticosteroids, methotrexate, cyclosporine) OR (b) High- or super-high potency topical corticosteroid
• Exception: requirement for conventional systemic therapy trial may be waived if patient has tried Leqselvi (deuruxolitinib tablets) or Litfulo (ritlecitinib capsules)
• Medication is prescribed by or in consultation with a dermatologist

Reauthorization criteria

• Patient age ≥ 18 years
• Patient established on Olumiant for ≥ 6 months
• Beneficial clinical response defined as improvement from baseline in extent and density of scalp hair loss
• Prescriber attests patient continues to require systemic therapy for alopecia areata

Approval duration

initial 6 months; reauth 1 year