Olumiant (baricitinib) — United Healthcare

Initial criteria

• Diagnosis of severe alopecia areata
• Patient is not receiving Olumiant in combination with either of the following:
• Targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Enbrel (etanercept), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Xeljanz (tofacitinib)]
• Potent immunosuppressant (e.g., azathioprine or cyclosporine)

Reauthorization criteria

• Documentation of positive clinical response to Olumiant therapy
• Patient is not receiving Olumiant in combination with either of the following:
• Targeted immunomodulator [e.g., adalimumab, Cimzia (certolizumab), Enbrel (etanercept), Orencia (abatacept), Rinvoq (upadacitinib), Simponi (golimumab), Xeljanz (tofacitinib)]
• Potent immunosuppressant (e.g., azathioprine or cyclosporine)

Approval duration

12 months