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.

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Permalink Reply by Carie on December 31, 2019 at 12:54pm

I can't believe this!!  If you have been diagnosed with an Auto Immune type of Alopecia, it isn't cosmetic!!  Let them lose all their hair and see how they then feel about it.  URGH!

Permalink Reply by Carma Harper on December 31, 2019 at 1:44pm

I tried to get the xeljanz med about a year ago and BCBS would not pay for mine. It is 1,000.00 a month and I can not afford it!! I have auto-immune Alopecia as well. 

Permalink Reply by Spuddy on December 31, 2019 at 10:29pm

yes I totally agree

where do you live Carie

Dan

Permalink Reply by Sam on December 31, 2019 at 12:56pm

How has this worked for your Alopecia? My rheumatologist has been reluctant to start me on it for Rheumatoid Arthritis, due to lymphoma concerns. He said the rates are higher than Orencia - which I’m currently taking. I am at a point where I would really like to see some hair regrowth and switch to Xeljanz. I didn’t even know Xeljanz was covered for Alopecia diagnosis, I was looking at using RA diagnosis ¯\_(ツ)_/¯ 
I have BCBS too 

Permalink Reply by Anisha on December 31, 2019 at 3:10pm

So Xeljanz isn't an FDA-approved treatment for Alopecia, but a lot of doctors are prescribing due to recent successes in trials... which is how most health insurance companies get away with not covering it, I imagine it will be an FDA-approved treatment any day now.

Permalink Reply by Sam on January 1, 2020 at 12:31pm

Argh! That must be the loophole insurance is using, approval  from FDA for a particular indication will mandate coverage, and strengthen legal standing. Without FDA approval they can argue it’s a “rogue” use and can cause harm. We may disagree based on existing data, but don’t have institutional backing that FDA approval guarantees. 

Permalink Reply by dreamscometrue on December 31, 2019 at 2:12pm

My health insurance never covered Xeljanz but covered every other biologic.  I was on Humira but had to stop because I was having problems on it. And I do also have autoimmune AU.  Always heard Xeljanz did better for AU.  Still looking to go to Mexico to get treated by Dr Lazo with antibiotics.  On his Youtube channel he cured a woman with AU using antibiotics

Permalink Reply by Anisha on December 31, 2019 at 3:12pm

Antibiotics has nothing to do with Alopecia ... its an autoimmune disease. Don't waste your time.

Permalink Reply by dreamscometrue on January 1, 2020 at 6:09pm

I know what an autoimmune disease is, but none of us know where it originates.  Research is to explore all options, and understanding the body and its mechanisms.  Chronic latent infection can cause all types of maladies that are called all kinds of things. 

Biologics mask the symptoms that cause the problem but dont cure the problem.  If you would think first to look at the patient in his video and the Dr's explanation for why he gives anti-biotics, before you judge, it may help you expand your thinking. 

If Biologics were the answer, then any of us with Alopecia would be cured/treated successfully using them.  But obviously, its not.  An old adage, Before you open your mouth, make sure your brain is fully loaded.

Permalink Reply by Apple on January 13, 2020 at 11:54pm

Mine started with gluten allergy, even if I do not. Inure gluten now the damage is done it does not stop.

Permalink Reply by Susan S on December 31, 2019 at 2:15pm

That's awful! What is the world coming to? I do not use Xeljanz but do use Clobetasol Propionate Cream for my alopecia ariata which is $hundreds, even with insurance. I also use Elequis for a different condition which is $500 a month with most insurances. But here's the good news, I was able to get the Clobetasol for $65 at Costco with a GoodRX card (just sign in on the website, it's free), and the Eliquis at a Canadian Pharmacy for around $250 for 3 months supply. Try both of these, I've used both of these places with great results. Call one and email the other for prices. And don't forget to try GoodRx too at local pharmacies. Happy Healthy New Year to everybody. 

Susan

Permalink Reply by Anisha on December 31, 2019 at 3:11pm

I would take hundreds of $$ over the thousands Xeljanz costs

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