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Attention Xeljanz Users!! New Alopecia classification leading to denial of coverage
Bad news for those of us using Xeljanz with health insurance. In August of this year, health insurance companies - Blue Cross Blue Shield Care First, specifically - reclassified Alopecia as a cosmetic/ aesthetic condition, rather than a medical condition/ disease. Consequently, they will no longer cover Xeljanz treatment because it is deemed cosmetic.
I'm considering suing. If anyone else has had their coverage of Xeljanz recently denied (since August 2019), please let me know.
Replies to This Discussion
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Permalink Reply by SabineTawni on
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I would also like to know if our disease is "cosmetic", why is eczema and psoriasis not cosmetic? Hair serves a function other than just providing a normal appearance. Just ask anyone with AU what it is like to have no hair anywhere (skin rashes, eye injuries from debris, sweat pouring into your eyes when you are driving a car and blinding you)!!
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Permalink Reply by dreamscometrue on
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That would be someone like me, with AU for almost 39 years now. The things I have to deal with in the summer with pollen flying in my eyes, debris from dust, even false eyelashes dont help much with that, my eyebrows if I draw them on sweat off, and I have to take more time to look "normal" than any other person is not cosmetic, but to blend in BECAUSE of my disorder. Insurance companies are for profit, not cures and it sickens me. If it cures, insurance companies want nothing to do with it
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Its all an end around coverage. If they label this a vanity issue they don't have to cover expensive meds like Xeljanz. Ironic, because they'll cover my topicals for the same thing.
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I just came from a new dermatologist. As I posted earlier I had been using Clobetasol Proponate for my AA, which comes and goes. He said to stop the Clobetsol, gave me shots, and said I could try Xeljanz which I had never heard of until I read the mssg on this website. I said it's not covered by insurance. He said no problem, he uses a compounding pharmacy and the copay would be $65 (not sure for how much, I go for a follow-up to see if it's working in 6 weeks). Those of you who are grappling with the cost might ask your Dr about this. It's mail order so it doesn't matter where you live. The name is MEDOZ Pharmacy of Polk 855-633-6948 (no idea what of Polk is referring to) www.medozrx.com. Good luck.
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I have a question for you, compound pharmacies make biologics???
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Xeljanz I know is a JAK inhibitor, and they lumped it into the other class of biologics, but are saying it does not work on manipulating the immune system the way other biologics do. I've never know it to come in cream form, but only pill form. I dont see how a topical cream would work for an autoimmune disorder that affects the entire immune system, and a person who has hair loss all over their body. It doesn't get to the source, it just mask the symptoms locally.
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Topical creams are ideal for a small area like the eyebrow or a vitiligo patch on your face so you don't have to get all the bad side effects. They're not meant to be used if you have big areas to cover.
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Xeljanz is labeled a biologic. My doctor refers to it as an immune modifier... So it does manipulate the immune system by inhibiting a small group of receptors responsible for the T-cell attack on the hair follicles... Rather than shutting down your entire immune system.
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I don't know how topical Tofinicitib would be effective, but apparently some people have gotten results. I would only use it supplement oral treatment.
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I’ll post again in 6 weeks, although if I have growth I won't know if it's from the med or the shots. I've had this for 20 years and don't really know if anything really works for me. I think it comes and goes when it wants to. But each time my hair starts to go, I’ll try whatever my Dr wants to try.
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