Study Finds Medicaid Coverage Gaps in Rosacea Treatments

TOPLINE:

State Medicaid formularies demonstrate significant variability in rosacea treatment coverage, with only 10% of states offering unrestricted access to basic therapeutic options, in an analysis of formularies in all 50 states.

METHODOLOGY:

• Researchers analyzed Medicaid formularies from all 50 US states and randomly selected one plan in states with multiple options.
• They reviewed preferred drug lists and formularies online, followed by emails and phone calls when information was incomplete or unavailable.
• Coverage categories were classified as: Covered without restrictions, step therapy required, prior authorization required, age limit, quantity limit, not covered, or unknown.

TAKEAWAY:

• Only 56% of states provided complete coverage information online, while 34% required additional communication through emails and calls to obtain formulary details, and 10% had unclear coverage details (representatives were not reachable or unsure of coverage).
• In general, systemic medications were more accessible than topical treatments.
• Most (78%) of states offered unrestricted coverage for at least one topical papule/pustule agent compared with 14% for redness treatments.
• Coverage of a basic rosacea armamentarium — at least one treatment each for redness (brimonidine or oxymetazoline), topical treatment of papules/pustules (azelaic acid, ivermectin, or metronidazole), and systemic therapy (doxycycline or isotretinoin) — was available without restrictions in 10% of states and with restrictions (such as prior authorization) in 68%.

IN PRACTICE:

“This study identifies considerable inconsistency in rosacea drug coverage and formulary transparency. Wide variation in formularies also suggests coverage decisions are not entirely evidence-based,” the authors wrote. “To prevent sequelae of disease,” they added, “it is important that patients with rosacea have access to treatments for the complete spectrum of signs and symptoms, including papules and pustules, redness, and phymatous changes.”

SOURCE:

The study was led by Weston Lowry, BA, Yale School of Medicine, New Haven, Connecticut. It was published online on January 15 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

Inclusion of only Medicaid formularies limited generalizability of results to populations with different insurance coverage.

DISCLOSURES:

The study was supported by the Yale School of Medicine Fellowship for Medical Student Research. Two authors disclosed serving on a data and safety monitoring board or receiving consulting fees from various pharmaceutical companies or dermatology care providers.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.