Diganosis: Alopecia areata.
Treatment: Olumiant.
The insurer denied: Olumiant.
The denial is: Upheld.

The patient is a male with alopecia areata. His beard is also affected. He has failed intralesional triamcinolone injections, mometasone, Opzelura, and minoxidil. The subject under review is the medical necessity for Olumiant.

The health plan's determination is upheld.

The requested health service/treatment of Olumiant is not medically necessary for this patient.
The Olumiant was denied by the plan because there was no SALT score of greater than 50%. The Severity of Alopecia Tool (SALT) score assesses the degree of hair loss, with 0 being no hair loss, and 100 being complete hair loss. Given that the hair loss in this patient is less than 50, it would not be considered severe enough to warrant a systemic therapy such as Olumiant, especially without exhausting all the topical therapies first.