Litfulo (ritlecitinib) — United Healthcare

Initial criteria

• Diagnosis of severe alopecia areata
• Patient is not receiving Litfulo in combination with a targeted immunomodulator [e.g., Olumiant (baricitinib), Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), adalimumab, Xeljanz (tofacitinib), Rinvoq (upadacitinib)]
• Patient is not receiving Litfulo in combination with a potent immunosuppressant (e.g., azathioprine or cyclosporine)

Reauthorization criteria

• Documentation of positive clinical response to Litfulo therapy
• Patient is not receiving Litfulo in combination with a targeted immunomodulator [e.g., Olumiant (baricitinib), Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), adalimumab, Xeljanz (tofacitinib), Rinvoq (upadacitinib)]
• Patient is not receiving Litfulo in combination with a potent immunosuppressant (e.g., azathioprine or cyclosporine)

Approval duration

12 months