Disparities in State Medicaid Coverage of Tretinoin for Pigmentary Disorders Compared to Acne Vulgaris
June 2024 | Volume 23 | Issue 6 | e151 | Copyright © June 2024
Published online May 16, 2024
Priya Manjaly BAa,b*, Kanika Kamal BAa,c*, Sophia Ly BAa,d, Katherine Sanchez BSa,e, Ethiopia Getachew BAc, Arash Mostaghimi MD MPA MPHa, Nicholas Theodosakis MD PhDf
aDepartment of Dermatology, Brigham and Women’s Hospital, Boston, MA
bBoston University School of Medicine, Boston, MA
cHarvard Medical School, Boston, MA
dUniversity of Arkansas for Medical Sciences, Little Rock, AR
eLake Erie College of Osteopathic Medicine, Erie, PA
fDepartment of Dermatology, Massachusetts General Hospital, Boston, MA
*Co-authors
Abstract
Background: Melasma and post-inflammatory hyperpigmentation (PIH) are common cosmetic dermatologic conditions that predominantly affect patients with skin phototypes III-VI. Comparing treatment coverage for these pigmentary disorders to treatment coverage for acne vulgaris may demonstrate disparities in insurance coverage for diseases that primarily affect patients of color.
Objective: Describe differences in Medicaid coverage for topical tretinoin for melasma and PIH vs. acne vulgaris in all 50 states and the District of Columbia.
Methods: This is a cross-sectional study of Medicaid insurance plans in all 50 states and the District of Columbia conducted between February 1 and 28, 2023. Data was collected from online publicly available preferred drug lists, prior authorization criteria, and email/telephone inquiries. Information was collected regarding coverage restrictions, including age restrictions, diagnostic restrictions, preferred drug status, and prior authorization requirements.
Results: Complete coverage data for all three clinical indications was retrieved from 30 (58.8%) states; partial coverage data for acne vulgaris was retrieved from 16 (31.4%) states; no coverage data was retrieved from 5 (9.8%) states. Of states reporting coverage data, topical tretinoin is covered in 45 (97.8%) states for acne vulgaris and 10 (33.3%) states for melasma and post-inflammatory hyperpigmentation. There was decreased Medicaid coverage of topical tretinoin for acne vulgaris compared to melasma and PIH (P<0.05).
Conclusion: There is differential Medicaid coverage for acne vulgaris compared to pigmentary disorders which disproportionately affect patients of color. Greater advocacy is required to ensure equal treatment for conditions that affect racial minority patients.
J Drugs Dermatol. 2024;23(6):e151-e153. doi:10.36849/JDD.8069e
INTRODUCTION
Melasma and post-inflammatory hyperpigmentation (PIH) are common conditions that predominantly affect patients with skin phototypes III-VI.1,2 These pigmentary disorders are often considered cosmetic despite their significant psychosocial morbidity, including depression and decreased quality of life.2
Tretinoin is a first-line treatment agent for melasma and PIH.3 Currently the FDA has approved tretinoin for the treatment of acne vulgaris, but not hyperpigmentation or melasma, despite acne's similar psychosocial morbidity profile.3,4 In this investigation, we examine Medicaid coverage of tretinoin for acne vulgaris, melasma, and PIH in 50 US states and the District of Columbia (DC).
MATERIALS AND METHODS
Information regarding Medicaid coverage of generic or brand-name tretinoin products for acne vulgaris, melasma, and PIH was collected for 50 states and DC in February 2023 (Figure 1). Data was collected online from publicly available preferred drug lists (PDLs) and prior authorization (PA) criteria or via email and telephone inquiries with the respective state Medicaid offices. In states with multiple PDLs for separate Medicaid plans, one plan was selected to represent the state. Plans were selected as state representatives if they covered the largest number of patients (Hawaii) or were the most easily accessible plans via online search (Arizona, California, Delaware, Indiana, New Mexico). All data for this study was collected from publicly available sources and institutional review board approval was not required.
