Insurance, Vitiligo, and You

James Nordlund, M.D.

There are a variety of treatments used commonly for vitiligo. Insurance coverage is available but variable for most of these. Insurance coverage often depends on the type of coverage. Those with very complete coverage will find obtaining treatments relatively easy. Those with limited policies will find at least some limitations on coverage for many treatments. Often insurance denies coverage. Letters appealing the decisions will reverse refusals in many cases, but not all of the time.

Office Visits

Insurance provides the usual office visit reimbursement, but deductibles and co-pays are patient responsibility. Consultants out of plans might not be covered. On occasion, referral by the primary care doctor is required for reimbursement.


Topical Steroids

Prescriptions for topical steroids of all varieties and strengths are reimbursed. Occasionally brand names are rejected in favor of comparable generic medications that are equally effective.


Immunomodulators

There are two immunomodulators used to treat vitiligo. These are Protopic and Elidel. Most insurance will reimburse for one or the other, sometimes either, medication. They can be substituted for one another if a policy provides for one but not the other.


Dovonex

This vitamin D analogue is reimbursed if it is on the formulary for the policy. Occasionally it is not on the formulary and will have to be purchased out of pocket.


Narrow Band Ultraviolet Light (Narrow Band UVB)

Most but not all insurance will reimburse for this type of ultraviolet light treatment. However, the patient is usually responsible for an office visit co-pay. Most light treatments are $60-80 per treatment and the patient is expected to pay small ($10) to moderate ($40) amounts per visit. Since treatments are given 2-3 times per week for as long as 6 months, the total cost to the patient can be substantial.


PUVA

PUVA treatment has two components, an oral chemical called Oxsoralen and exposure to ultraviolet light (UVA). Most insurance pays for the medication Oxsoralen. Some will reimburse for the UVA, however many will not if the PUVA is administered for vitiligo. In contrast, most insurance covers PUVA for psoriasis. Vitiligo is considered cosmetic whereas psoriasis is considered a medical problem by many insurance companies. If the UVA is covered by the insurance, it will follow the same rules as for Narrow Band UV treatment.


Benoquin

Benoquin is used for depigmentation. About half of insurance companies reject this prescription, but many will reconsider if a letter of appeal is written. A few are adamant and will refuse all reimbursement. Benoquin is considered a cosmetic treatment. It is rather expensive if paid for out of pocket.


Other Treatments

Vitamins, pseudocatalase, and treatments from the Internet are all considered outside of standard care and are not reimbursed. Some vitamins given in higher doses by prescription, such as folic acid, might be reimbursed but are inexpensive out of pocket.


Letters of Appeal

It is worthwhile to have your doctor write a letter appealing any denials of coverage. Listed below are important elements, all of which are true, to include in the letter:

• Vitiligo is probably an autoimmune disorder.


• Depigmented skin is more susceptible to sunburn.


• Depigmented skin does not function normally.
• The purpose of treatment is to return the skin to normal structure and function.


• The patient does get cosmetic improvement but that should not be reason for denial since all dermatological treatments, such as for acne and psoriasis, also produce cosmetic improvement while improving the skin functionally.


• Treatments are not ongoing, but rather are for 3 to 6 months generally. At times they are intermittent and can continue longer than 6 months.


• Especially for individuals with dark skin, it might be worth mentioning some egregious social event due to the visible depigmentation, e.g. rejection, embarrassing public moment, problems at work. These should appeal to the emotional feelings of the insurance reviewers who would not like to suffer similar problems.

The National Vitiligo Foundation has, and will continue to, advocate with insurance companies to improve coverage for individuals with vitiligo. To do so most effectively, the Foundation needs to have a large membership base so that it can leverage numbers (thousands of individuals) in conversations with these companies. Please become a member of the Foundation if you have not already done so, and consider asking your family and friends to also join. There is no cost.