LITFULO (ritlecitinib)

LITFULO (ritlecitinib)

Self-Administration – Oral

Diagnosis considered for coverage:

• Alopecia Areata (AA): Indicated for the treatment of adult and adolescent patients 12 years and older with severe alopecia areata. Not recommended for use in combination with other JAK inhibitors, biologic immunomodulators, cyclosporine or other potent immunosuppressants.

Coverage Criteria:

• Diagnosis of alopecia areata, AND
• Patient has at least 50% scalp hair loss, AND
• Other causes of hair loss have been ruled out (e.g., other types of alopecia, scalp disease, active systemic disease), AND
• Patient is 12 years of age or older, AND
• Prescribed by or in consultation with a dermatologist, AND
• Not used in combination with other JAK inhibitors, biologic immunomodulators, cyclosporine or other potent immunosuppressants

Reauthorization Criteria:

1. For diagnosis of alopecia areata:

• Documentation of positive clinical response to therapy, AND
• Not used in combination with other JAK inhibitors, biologic immunomodulators, cyclosporine or other potent immunosuppressants

Coverage Duration:

• Initial: 12 months
• Reauthorization: 12 months

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Additional Information:

• Litfulo (ritlecitinib) is an orally administered JAK3 and TEC inhibitor indicated for the treatment of severe AA in adults and adolescents 12 years and older.
• Alopecia areata is an autoimmune disease for which there are limited treatment options. Options such as corticosteroids, immunosuppressants, calcineurin inhibitors, and minoxidil have been used off-label.
• Lituflo carries a Boxed Warning for serious infections, mortality, malignancy, major adverse cardiovascular events, and thrombosis. It is not recommended for use in combination with other JAK inhibitors, biologic immunomodulators, cyclosporine or other potent immunosuppressants.

Policy Updates:

• 02/20/2024 – New policy approved by P&T.

References:

1. Litfulo Prescribing Information. Pfizer. New York, NY. June 2023.
2. King B, Zhang X, Harcha WG, et al. Efficacy and safety of ritlecitinib in adults and adolescents with alopecia areata: a randomised, double-blind, multicentre, phase 2b-3 trial. Lancet. 2023;401(10387):1518-1529.