Diagnosis: Skin Disorders-alopecia areata
Treatment: Pharmacy/Prescription Drugs
The insurer denied Xeljanz.
The denial is overturned.

The patient is a male with alopecia areata (AA), treated with topical and oral steroids, topical minoxidil and topical Xeljanz. The patient has responded well to oral Xeljanz. The subject under review is the medical necessity for the medication.

The treatment with Xeljanz is medically necessary for this patient.

A wide range of treatments have been used for the management of alopecia areata, most of which are not highly effective. A dependable and safe treatment for extensive disease (totalis or universalis) has yet to be found. Given the rarity of the disease, large randomized controlled trials are extremely difficult.

Tofacitinib (Xeljanz) first demonstrated efficacy in alopecia areata in the article published in 2014. Since then, further case reports have emerged documenting its efficacy, which has led to the very recently published retrospective studies involving adults and adolescents, as well as others.

Therefore, given the support in current literature and lack of effective therapies for alopecia areata, and this patient's favorable response to therapy, Xeljanz is medically necessary. Withdrawal of this medication for this patient will result in substantial negative impact on disease course.