Alternatives to Olumiant If You Can't Fill Your Prescription

Running out of Olumiant — or being unable to access it — can be stressful, especially if you rely on it for rheumatoid arthritis or alopecia areata. The good news is that there are real alternatives to discuss with your doctor. This guide covers the most relevant options by condition. Always talk with your prescriber before making any changes to your medication.

Important: Don't Stop Olumiant Without Talking to Your Doctor

Stopping baricitinib abruptly — without a plan in place — can lead to a return of symptoms, sometimes quickly. For rheumatoid arthritis, stopping any DMARD without a replacement can cause a rapid flare. For alopecia areata, hair loss typically returns after discontinuing JAK inhibitors. Before making any changes, call your rheumatologist or dermatologist to discuss a transition plan.

Alternatives for Rheumatoid Arthritis (RA)

Olumiant is approved for adults with moderately to severely active RA who haven't responded to one or more TNF blockers. If you can't access it, these are the main alternatives your doctor might consider:

Other JAK Inhibitors for RA

Xeljanz (tofacitinib): The first FDA-approved oral JAK inhibitor for RA (2012). It inhibits JAK1 and JAK3 (different from Olumiant's JAK1/JAK2 profile). Available in immediate-release and extended-release formulations. Has a well-established safety track record with similar boxed warnings as Olumiant.

Rinvoq (upadacitinib): A selective JAK1 inhibitor approved for RA in 2019. Clinical studies suggest upadacitinib and baricitinib are considered therapeutically equivalent for RA. Also approved for atopic dermatitis, psoriatic arthritis, ankylosing spondylitis, and Crohn's disease.

Biologic DMARDs for RA (Injectable Alternatives)

If JAK inhibitors aren't an option, biologic DMARDs are the other major class for moderate-to-severe RA. These require injection or infusion but have been used for decades:

Orencia (abatacept): A biologic that blocks T-cell activation; available as weekly subcutaneous injection or monthly infusion

Actemra (tocilizumab): An IL-6 receptor blocker available as subcutaneous injection; can be used as monotherapy or with methotrexate

TNF blockers (adalimumab/Humira, etanercept/Enbrel): Anti-TNF biologics; Olumiant is specifically indicated for patients who have FAILED TNF blockers, so these may not be appropriate re-starts for many patients

Alternatives for Alopecia Areata (AA)

Olumiant was the first systemic treatment approved for severe alopecia areata (June 2022). Since then, two more FDA-approved oral JAK inhibitors have become available for AA:

Litfulo (ritlecitinib): FDA-approved in 2023 for severe alopecia areata in adults and adolescents aged 12 and older. A JAK3/TEC inhibitor. Approved for a broader age range than Olumiant and is a strong alternative if Olumiant isn't accessible.

Leqselvi (deuruxolitinib): FDA-approved in mid-2024 for severe alopecia areata in adults. A newer addition to the FDA-approved AA treatment options. Commercial availability is still rolling out.

Xeljanz (tofacitinib) — off-label: Some dermatologists prescribe tofacitinib off-label for alopecia areata, especially for patients who were already on it before FDA-approved options existed.

What to Tell Your Doctor If You Can't Access Olumiant

When you call your prescriber, be prepared to explain:

Why you can't access Olumiant (prior auth denial, specialty pharmacy unavailable, cost issue, etc.)

How long you've been without medication and what symptoms you're experiencing

Whether you'd prefer to stay on a JAK inhibitor or would consider a biologic

Your insurance situation (commercial insurance, Medicare, Medicaid, or uninsured)

Before Switching: Try to Locate Olumiant First

Switching medications is a significant decision that takes time, carries its own risks, and may require additional prior authorizations. Before committing to an alternative, use medfinder.com to check if Olumiant is available at a specialty pharmacy near you. Our guide on how to find Olumiant in stock covers step-by-step strategies that have helped many patients locate their medication without switching.