Litfulo — Medical Mutual

Alopecia areata

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
Patient does not have hair loss due to androgenetic alopecia, chemotherapy-induced hair loss, or other causes of hair loss other than alopecia areata; AND
The medication is prescribed by or in consultation with a dermatologist

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

initial 6 months; reauth 1 year