Alternatives to Baricitinib If You Can't Fill Your Prescription

When You Can't Get Baricitinib: Know Your Options

If you've been prescribed Baricitinib (Olumiant) and can't fill your prescription — whether due to availability, insurance issues, or cost — you're probably wondering: what else can I take?

The answer depends on your specific condition, medical history, and what your doctor recommends. But there are several alternatives in the same drug class that may work for you. In this guide, we'll walk through what Baricitinib does, how it works, and the most common alternatives your doctor might consider.

Important: Never switch medications on your own. Always talk to your doctor before making any changes to your treatment plan.

What Is Baricitinib and What Does It Treat?

Baricitinib is a Janus kinase (JAK) inhibitor sold under the brand name Olumiant. It's manufactured by Eli Lilly and Company and comes as a tablet you take once daily by mouth.

The FDA has approved Baricitinib for:

• Rheumatoid arthritis (RA) — in adults who haven't responded well to TNF inhibitor therapies like Adalimumab (Humira) or Etanercept (Enbrel)
• Severe alopecia areata — a condition that causes significant hair loss due to the immune system attacking hair follicles
• COVID-19 — in hospitalized adults who need supplemental oxygen or ventilation

For a complete overview, visit our guide on what Baricitinib is and how it's used.

How Does Baricitinib Work?

Baricitinib works by blocking two specific enzymes called JAK1 and JAK2. These enzymes are part of the JAK-STAT signaling pathway, which helps immune cells communicate and activate. When JAK1 and JAK2 are overactive, they can trigger too much inflammation — leading to joint damage in rheumatoid arthritis or hair follicle destruction in alopecia areata.

By inhibiting these enzymes, Baricitinib turns down the immune system's overreaction without shutting it off completely. Learn more in our detailed mechanism of action explainer.

Alternatives to Baricitinib

If you can't get Baricitinib, the following medications work through similar mechanisms. Your doctor will help determine which one is right for your specific condition.

1. Tofacitinib (Xeljanz)

Drug class: JAK inhibitor (JAK1, JAK2, JAK3)

FDA-approved for: Rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, polyarticular course juvenile idiopathic arthritis

How it's taken: Oral tablet, 5 mg or 10 mg, taken twice daily (or 11 mg extended-release once daily)

How it compares: Tofacitinib is the most established JAK inhibitor, approved since 2012. It blocks JAK1, JAK2, and JAK3, making it slightly broader than Baricitinib. For rheumatoid arthritis patients, it's often a direct alternative. It is not FDA-approved for alopecia areata, though some doctors may use it off-label.

Cost: Around $2,400 to $2,800 per month without insurance. Generic Tofacitinib may become available, which could reduce costs significantly.

2. Upadacitinib (Rinvoq)

Drug class: Selective JAK1 inhibitor

FDA-approved for: Rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, ulcerative colitis, Crohn's disease, ankylosing spondylitis

How it's taken: Oral tablet, 15 mg or 30 mg once daily

How it compares: Upadacitinib is a newer JAK inhibitor made by AbbVie that selectively targets JAK1. It has one of the broadest indication profiles of any JAK inhibitor. For rheumatoid arthritis, it's considered a strong alternative to Baricitinib. It is not currently approved for alopecia areata.

Cost: Approximately $2,700 to $3,200 per month without insurance. AbbVie offers savings programs for eligible patients.

3. Ritlecitinib (Litfulo)

Drug class: JAK3/TEC family kinase inhibitor

FDA-approved for: Severe alopecia areata in adults and adolescents aged 12 and older

How it's taken: Oral capsule, 50 mg once daily

How it compares: If you take Baricitinib specifically for alopecia areata, Ritlecitinib is the most direct alternative. It was approved by the FDA in 2023 and targets a different combination of kinases (JAK3 and TEC family). It does not carry the same boxed warning about cardiovascular events and malignancies that other JAK inhibitors have, though long-term safety data is still being collected.

Cost: Around $2,500 to $3,000 per month without insurance. Pfizer offers a savings program for eligible patients.

4. Abrocitinib (Cibinqo)

Drug class: Selective JAK1 inhibitor

FDA-approved for: Moderate-to-severe atopic dermatitis in adults

How it's taken: Oral tablet, 100 mg or 200 mg once daily

How it compares: Abrocitinib is primarily an option if Baricitinib is being used off-label for atopic dermatitis. Made by Pfizer, it selectively targets JAK1 and is specifically designed for skin inflammation. It would not be appropriate for rheumatoid arthritis or alopecia areata.

Cost: Approximately $2,600 to $3,100 per month without insurance.

How to Choose the Right Alternative

The best alternative depends on:

• Your condition — RA, alopecia areata, and atopic dermatitis each have different preferred treatments
• What you've tried before — insurance often requires step therapy, so your history matters
• Side effect profile — all JAK inhibitors carry a boxed warning (except Ritlecitinib for now), but individual risk varies
• Insurance coverage — your plan may cover one JAK inhibitor but not another
• Cost — manufacturer savings programs vary

Talk to your doctor about which alternative makes the most sense for you. You can also check availability and pricing for these medications on Medfinder.

Final Thoughts

Not being able to fill your Baricitinib prescription is frustrating, but you have options. Several JAK inhibitors are available that work through similar mechanisms and may be covered by your insurance. The key is working with your doctor to find the right fit.

Before switching, you might also want to try our tips for finding Baricitinib in stock or explore savings programs that could make the original prescription more accessible.