New oral therapy for severe alopecia areata puts pressure on other public plans
Ontario’s public drug plan now covers the first medicine for severe alopecia areata, setting a precedent other provinces may face pressure to follow.
Eli Lilly Canada Inc. says Ontario is the first province to list Olumiant (baricitinib) for adult patients with severe alopecia areata on its public drug formulary, making it the first and only publicly reimbursed treatment for this condition in Canada.
Health Canada authorized Olumiant for adult patients with severe alopecia areata on January 26, 2024.
The decision relied on Lilly’s BRAVE-AA1 and BRAVE-AA2 Phase 3 trials, which evaluated efficacy and safety in 1,200 adults with severe disease, defined as at least 50 percent scalp hair loss using a Severity of Alopecia Tool (SALT) score of 50 or higher.
On October 2, 2024, Canada’s Drug Agency – L’Agence des medicaments du Canada (CDA-AMC) – issued a positive final reimbursement recommendation with conditions for Olumiant as a first-line advanced therapy for severe alopecia areata.
That recommendation followed a pan-Canadian Pharmaceutical Alliance (pCPA) negotiation that concluded with a letter of intent on November 10, 2025, marking the first time a medicine for severe alopecia areata in Canada has completed public reimbursement negotiations with the pCPA.
Merlet said Ontario is “taking the lead in giving people with alopecia areata access to an effective treatment option, Olumiant.”
“Olumiant is the first and only oral medicine approved for severe alopecia areata with a Letter of Intent from the pan-Canadian Pharmaceutical Alliance (pCPA),” she said, adding that Lilly Canada wants public drug plans to act quickly so patients with the condition can access the drug through their plans.
Clinicians describe alopecia areata as an immune-mediated condition that can significantly affect quality of life.
Beecker said alopecia areata “is an immune‑mediated condition that can impact patients’ quality of life.”
She said clinicians “have seen clinical benefit from targeted systemic therapies such as JAK inhibitors — including Olumiant (baricitinib) — in cases of severe alopecia areata,” an area where patients have historically had few treatment options.
She added that Ontario’s first public listing following the pCPA decision is a step toward making targeted therapies like baricitinib available through public drug plans for people with severe alopecia areata.
Patient advocates also highlight the psychosocial dimension.
Harrison said alopecia areata “is more than just hair loss” and that hair is “often closely tied to personal identity.”
She said losing hair can be distressing for people living with severe alopecia areata and that members of the community want nationwide access to Olumiant.
Despite federal-level approvals and national reimbursement processes, access remains uneven.
In Québec, "medications prescribed to treat alopecia or baldness" appear under section 6.2.4.1 as "Medications excluded" on the public drug formulary (RAMQ).
As a result, medicines such as Olumiant are not evaluated by the Institut national d'excellence en santé et en services sociaux (INESSS) for public reimbursement, even though several federal public access programs provide public reimbursement for Québec residents.
Lilly says this exclusion creates inequitable access for Québec residents living with this immune-mediated condition and is seeking to re-engage with INESSS and the Ministry of Health in Québec to have the policy reconsidered.
