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Xeljanz coverage denied
Are there any Xeljanz users whose insurance has suddenly denied coverage of their meds? Some insurance providers, including Blue Cross Blue Shield Care First has changed their rules so they no longer consider Alopecia a medical condition/ disease, but a cosmetic or aesthetic concern, so they no longer have to cover it. Even so for patients who have seen positive results.
Replies to This Discussion
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Permalink Reply by hagster on
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Most insurance denied from the start because hair growth is considered an off label use of Xeljanz. Now, if you really needed that drug for its intended usage, it might be different. Insurance knows how expensive Xeljanz is and that if it is prescribed for hair growth that it is a lifelong commitment and they're not willing to commit to pay that long.
Hair loss from Cancer, which is life threatening and life shortening, is a different matter even for something as simple as supplying wigs as dme.
Finally, I think alopecia is becoming so common in todays world that insurance companies consider it almost in the realm as being overweight. They are not going to buy you Spanx to make you look better.
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Permalink Reply by Anisha on
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Yah, i get that. But Alopecia a legitimate autoimmune disease, not just a cosmetic issue. And to change horses mid-race so they no longer have to cover it is just wrong,
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Permalink Reply by NicoleT on
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Hi! this happened to me as well Blue Cross covered me for one month and then took it back I did several appeals with no luck I switched insurance companies to United healthcare and they would not cover me either. It’s ridiculous.
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This denial of coverage will soon also affect wig users. The first cases denying wig costs were made in the EU recently. Although some might be against the use of Xeljanz and other medication the insurance cover issues might affect all of us in a similar manner.
It is important that a precedence legal case will be created soonest in a western jurisdiction, preferable US, dealing with the question whether AA is really "just cosmetic" or not.
Of course insurers are bringing this up now because Xeljanz is used widely and new medications are in prep., and their main concern is that AGA-man will come and claim their costs for hair transplant surgeries arguing there is "no difference between AGA and AA".
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