Diagnosis: Alopecia
Treatment: Xeljanz
The insurer denied: Xeljanz
The denial is upheld.

The patient is an adult female with severe alopecia areata of the scalp with almost complete hair loss. She has been treated with intralesional and oral steroids, as well as topical medication without effect. The condition makes her depressed and causes social problems. This is a request to approve Xeljanz for the treatment of her alopecia.

The requested Xeljanz is not medically necessary.

The patient has severe alopecia areata that has failed intralesional and oral steroids, as well as topical medications. Her physician is requesting Xeljanz, which the patient has not taken in the past. Xeljanz is not FDA (United States Food and Drug Administration) approved for the treatment of alopecia areata, although there have been a number of case reports and small clinical trials reporting promising outcomes of tofacitinib. In view of the fact that another JAK (janus kinase) inhibitor, Olumiant (baricitinib), is FDA (United States Food and Drug Administration) approved for the treatment of alopecia areata and there is no documentation that the patient has used it, Xeljanz cannot be considered medically necessary for this patient.