• Has Medicare Part D Denied You Coverage for an FDA-Approved Alopecia Areata Treatment?

  • If Medicare Part D has denied, delayed, or restricted coverage for an FDA-approved JAK inhibitor (Olumiant, Litfulo, Leqselvi) prescribed for alopecia areata, we want to hear from you.

     

    Not sure if your plan is part of Medicare Part D? If you've received a denial letter for coverage of your FDA-approved JAK inhibitor, we'd like to see it.

     

    Your experience matters. This information will be solely used to advocate for fair Medicare Part D coverage of FDA-approved alopecia areata treatments. All information is kept confidential. 
     
    Instructions: This form takes about 10-15 minutes. Before you start, collect your insurance card and your written denial letter. No letter? You can still submit information about your denial. 
     
    You will be asked to upload a photo (JPG or PNG) or a scanned document (PDF) of your letter, if you have one. Before uploading, please make a copy of your original letter and keep the original letter for your records. To protect your privacy, on the copy, please black out the following using a marker or other tool: 

     

    • Medicare ID number 
    • Social Security number 
    • Date of birth 
    • Full mailing address 
    • Phone number 
    • Email address 

  • Leave visible: the name of your insurance plan, medication denied, reason given for the denial, date of the denial, and any appeal information. 

     

    Questions? Email Julie Wallace, NAAF Senior Director, Government Affairs & Advocacy, at julie@naaf.org  

  • Section 1: About You (Required) 

  • Section 2: Your Medicare Part D Plan (Required) 

  • State where you are enrolled*

  • Section 3: The Denial (Required) 

  • Approximate date of denial?*
     - -
    2 digit month, 2 digit day, 4 digit year
  • How was the denial communicated to you? (check all that apply)*

  • Section 4: Appeals (if applicable; Optional) 

  • What was the outcome?

  • Section 5: Impact (Required) 

  • What happened as a result of the denial?*

  • Section 6: Upload your Denial Letter

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  • Section 7: Consent (Required) 

  • I confirm that:

    • The information I have submitted is accurate to the best of my knowledge 
    • I agree that anonymized, aggregated data from this and other submissions may be shared with the Centers for Medicare & Medicaid Services (CMS) and used for advocacy purposes to improve coverage of FDA-approved alopecia areata treatments 
    • I understand my personal contact information will never be shared publicly or with CMS 
    • I understand that my full submission will be kept confidential 
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