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Medicare AdvantagePrior AuthMedium impact

Litfulo™ (ritlecitinib) (Revised)

Humana·Dermatology·Medicare Advantage
Effective date
Sep 27, 2023
We identified it
Jun 25, 2026
Days to comply
—

Summary

Humana Medicare Advantage has revised its prior authorization policy for Litfulo™ (ritlecitinib) effective September 27, 2023, with updates as of September 24, 2025. The policy requires prior authorization for this JAK inhibitor used to treat severe alopecia areata, with specific clinical criteria including ≥50% scalp hair loss (SALT score), prior treatment failure/intolerance to corticosteroids or cyclosporine, and prohibition of concurrent use with other JAK inhibitors or potent immunosuppressants. Billing teams must ensure all Litfulo requests include prior authorization and verification of the three approval criteria before claim submission.

Action Required

Action needed
REQUIREMENTS: - Effective immediately: Billing and prior authorization teams must implement prior authorization requirement for all Litfulo™ (ritlecitinib) 50mg capsule claims submitted to Humana Medicare Advantage plans. - Before claim submission: Verify that member documentation includes: (1) diagnosis of severe alopecia areata with ≥50% scalp hair loss documented on SALT (Severity of Alopecia Tool); (2) evidence of prior treatment, contraindication, or intolerance to corticosteroids (e.g., betamethasone valerate lotion) or cyclosporine capsules; and (3) confirmation member is NOT concurrently using JAK inhibitors, biologic immunomodulators, cyclosporine, or other potent immunosuppressants. - Update prior authorization request forms and clinical templates to require attachment of SALT score documentation and prior treatment history. - Train billing staff, providers, and authorizers on the three clinical criteria for approval and the black box warnings (serious infections including TB, malignancies, thrombosis). - Alert prescribing providers that claims will be DENIED without prior authorization and supporting clinical documentation meeting all three criteria. - Reference CMS NCDs, LMRPs, and LCDs for any additional Medicare coverage requirements at http://www.cms.hgs.gov/.

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