Challenges of Securing Insurance Approval for Oral Tofacitinib Treatment of Alopecia Areata: A Multi-Institutional Retrospective Review

The document from July 1, 2020, highlights the challenges faced in securing insurance approval for oral tofacitinib, a drug approved for rheumatoid arthritis but used off-label for alopecia areata (AA), an inflammatory hair loss disorder. The retrospective review included 38 AA patients from two academic medical centers. Insurance approval was initially denied for 89% (34/38) of the patients, with 71% (27/38) ultimately failing to obtain coverage. The denials were mainly due to the medication being off-label for AA. Additionally, 34% (13/38) of the patients reported a decreased quality of life or suicidal ideation, with 7 of these 13 patients never receiving insurance approval for tofacitinib. The study underscores the need for policy changes to address the approval barriers for medications like tofacitinib that show efficacy in treating conditions like AA but lack FDA approval for that specific use.