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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 Panja on
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I have also been taking Xeljanz for about 3 years now and applied for the phyzer assistance program and they have covered everything since then. And i have all my hair back since I have been taking it
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Permalink Reply by Austen on
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Someone has to alert American NAAF. The insurance plan trouble (ie labeling AA as "cosmetic") can motive pharma enterprise to quit similarly improvement of AA medication. Also the insurers and public health carriers will start denying cowl for wigs as they start doing it in the EU (started in Germany), respectively they will solely cowl very low priced ones. So the ladies will have troubles in the future too. The NAAF like corporations in the EU are no longer daring ample to take care of this problem click here. The american NAAF desires to take care of that. A precedence legal case desires to be created with top notch dermatologists like Brett King as experts. Once one case is gained in the US the entire insurance plan enterprise world huge will give up denying cover.
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Also my xeljanz is prescribed for RA so insurance should not be able to turn that down maybe you can get it prescribed for another reason than the Alopecia
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My personal feeling is that we will only need to use Xeljanz for some two years as from now. There will be another small molecule based medication ("Jak inhibitor") with lower risk profile coming soon. Pfizer has developed one and they have already invested heavily into this, so I do not think their shareholders will appreciate any withdrawal. There will be another medication coming some 10 years afterwards being close to a cure. It will be something based on this IL 15 inhibition being prepared by Bioniz. I also have the feeling the major obstacle going forward as from today will be insurance and/or public health coverage. All insurers and public health providers worldwide fear that people with AGA will come and claim their hair transplant costs from them, in case AA will have a medication being covered, because AGA-man will argue that AA and AGA are similar - which is nonsense of course. I have been to Istanbul recently for business and found out that it is a major European hub for hair transplant. The airport was full of men wearing these post-transplant-surgery caps. This is real business and our health system in the EU would get into turmoil if we need to cover this, whilst I guess the spending for some people with AA would be peanuts in comparison.
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I hope you're right. I was informed there are several other biologicals in the works. I also learned that my dog takes the tofanacitib (Xeljanz), But its only $2 a pill rather than the $300 a pill Pfizer charges humans.
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What I do not understand is that insurance companies will usually cover the cost of wigs for cancer patients, but do not cover wigs for Alopecia Areata patients. Why??? Hairloss from cancer treatment is very short-term and temporary. Hairloss from Alopecia Areata is often long-term and sometimes permanent. I can only assume the insurance companies are make a decision based on politics. Can you imagine the outcry if a cancer patient was denied coverage for a wig??
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You are so right!! I have AU and it is permanent hair loss probably forever unless they find a cure!! It is really sad there is not more awareness for us with alopecia. I have joined a support group here in Tennessee and that has helped!! I feel like if one person from the insurance companies has alopecia, they would understand fast!!
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Permalink Reply by dreamscometrue on
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Agreed! But insurance companies know, there is no profit in a cure. So they will approve a "band-aid" if it makes them money, even if the band-aid causes secondary illnesses, as long as it keeps making them money from pharmaceutical companies
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Bingo, unfortunately pharma is massive business. Why would they want to get rid of their customers? It is sad that some companies put money over human health.
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Permalink Reply by Apple on
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All companies put money first over actually helping people. It’s not cosmetic it’s a sx of an autoimmune disorder it’s medical, it is BS. I’m in the process of hiring a lawyer to dispute this no coverage for medical necessity medication. Well I go see a lawyer tomorrow. They will never allow up to be normal what kind of stuff is this. We suffer when their is rx that eradicated our symptoms. I’ve cried enough over my AA. I want to live and not worry about this any longer.
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