Medicare AdvantagePrior AuthMedium impact
Litfulo™ (ritlecitinib) (Revised)
Humana·Dermatology, Allergy & Immunology·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
Humana Medicare Advantage updated its prior authorization policy for Litfulo (ritlecitinib) for severe alopecia areata, effective July 22, 2026. The policy requires prior authorization and mandates that patients meet all three criteria: severe alopecia areata with ≥50% scalp hair loss documented by SALT score for 6+ months, prior treatment/contraindication/intolerance to corticosteroids or cyclosporine, and no concurrent use with other JAK inhibitors or potent immunosuppressants. Claims submitted without meeting these criteria or without prior authorization will be denied.
Action Required
By July 22, 2026: Billing team must implement prior authorization requirement for Litfulo (ritlecitinib) in the claims processing system for all Medicare Advantage members. Update provider ordering templates and patient eligibility verification workflows to flag Litfulo prescriptions for prior auth review. Providers must document in claims that patients meet all three coverage criteria (SALT score ≥50% with 6+ month duration, prior corticosteroid or cyclosporine treatment/contraindication/intolerance, and no concurrent JAK inhibitors or immunosuppressants). Contact Humana's PAL portal at www.humana.com/PAL for claim code submission requirements. Failure to obtain prior authorization before dispensing will result in claim denials and potential member balance billing.