Medicaid Coverage of JAK Inhibitors for Alopecia is Limited | AAD 2025

Despite the significant burden of alopecia, Medicaid coverage for JAK inhibitors used to treat this autoimmune disease is highly variable and restricted, especially through prior authorization criteria, according to a poster presented at the American Academy of Dermatology (AAD) Association annual meeting in Orlando, March 7, 2025, to March 11, 2025.

Alopecia areata affects about 700,000 people in the United States, and 300,000 have severe alopecia areata. Alopecia areata is a common autoimmune disease in which hair loss is thought to occur due to the immune system targeting the hair follicles and causing sudden hair loss on the scalp, face and sometimes other areas of the body.

Previous studies have suggested that the JAK pathway contributes to hair loss in severe alopecia areata, and use of JAK inhibitors can lead to hair regrowth.

Several Janus kinase (JAK) inhibitors are available for treating moderate-to-severe alopecia areata, the most recent being the July 2024 FDA approval of the twice-daily Leqselvi (deuruxolitinib) tablets. Others include Pfizer’s Litfulo (ritlecitinib), a once-daily oral treatment approved in June 2023, and Eli Lilly’s Olumiant (baricitinib) oral tablet approved in June 2022. Olumiant is also approved to treat rheumatoid arthritis.

Litfulo has a wholesale acquisition cost of $3,769.23 for 28 tablets. Olumiant has a list price of $2,767.39 for a 30-day supply of 2 mg tablets or $5,534.78 for a 30-day supply of 4 mg tablets

In the current study, researchers Megan Hoang, BA, of the Warren Alpert Medical School of Brown University and Harry Dao Jr., M.D., in the department of Dermatology, Loma Linda University, wanted to assess the extent of Medicaid coverage for FDA-approved JAK inhibitors and determine the difference in coverage for Olumiant for treating alopecia areata compared with rheumatoid arthritis.

Researchers assessed coverage of FDA-approved JAK inhibitors for alopecia in all 50 states and the District of Columbia. They also considered Medicaid formularies and prior authorization criteria for coverage of Olumiant, Litfulo, and Leqselvi as of October 2024. Coverage was categorized as unrestricted, prior authorization required, or not covered.

They found that both Olumiant and Litfulo were covered by 52.9% of plans; 15.7% of plans covered only Olumiant. One state (Montana) covered only Litfulo.

Researchers found that prior authorization is required by an overwhelming majority of plans; 96.4% of plans covering Litfulo require prior authorization, and 91.4% of plans covering Olumiant require prior authorization. Only Hawaii had unrestricted coverage of both drugs. Among all the states, 29.4% did not cover either drug.

Additionally, 98.0% of plans covered Olumiant for rheumatoid arthritis, while only 43.1% of plans covered Olumiant for alopecia. “A large coverage gap exists for access to baricitinib for treating AA versus RA," researchers wrote. “This may be partly due to baricitinib’s FDA approval for RA four years earlier than for AA.”