[vc_row type=”in_container” full_screen_row_position=”middle” column_margin=”default” column_direction=”default” column_direction_tablet=”default” column_direction_phone=”default” scene_position=”center” text_color=”dark” text_align=”left” row_border_radius=”none” row_border_radius_applies=”bg” overflow=”visible” overlay_strength=”0.3″ gradient_direction=”left_to_right” shape_divider_position=”bottom” bg_image_animation=”none”][vc_column column_padding=”no-extra-padding” column_padding_tablet=”inherit” column_padding_phone=”inherit” column_padding_position=”all” column_element_spacing=”default” background_color_opacity=”1″ background_hover_color_opacity=”1″ column_shadow=”none” column_border_radius=”none” column_link_target=”_self” column_position=”default” gradient_direction=”left_to_right” overlay_strength=”0.3″ width=”1/1″ tablet_width_inherit=”default” tablet_text_alignment=”default” phone_text_alignment=”default” animation_type=”default” bg_image_animation=”none” border_type=”simple” column_border_width=”none” column_border_style=”solid”][vc_column_text]Health insurance coverage is strongly related to better health care outcomes. Individuals without insurance or those who are underinsured are more likely to forgo preventive care. They may only pursue care when their disease or condition is at a more advanced stage.
Blundell et al. (2021) reviewed how vitiligo treatment coverage policies affect health care outcomes and lead to disparities for children of color. Many health care insurers do not cover vitiligo treatment as they consider the condition purely cosmetic. As a result, treatment is less accessible and affordable for those with vitiligo, especially people of color. However, insurances cover the treatment of other diseases that affect physical appearance along with other skin-related symptoms, such as acne, alopecia areata, pityriasis alba, and dermatitis.
Patients are keen to begin treatment in a timely fashion. However, they experience a poorer quality of life as their disease worsens and progresses. Treatment availability may lower stress and anxiety due to social interactions, stigma, self-image, and appearance-related concerns; and improve the progression of the disease.
The researchers surveyed 15 commercial health care insurers, 50 BlueCross BlueShield plans, Medicaid, Medicare, and the Department of Veteran Affairs. The researchers collected information on the level of vitiligo treatment coverage by conducting an online review of insurance policy documents, phone calls, and surveys. In addition, they evaluated information on office visits, medications, excimer laser therapy, phototherapy with UVA, and narrow-band UVB.
Insurers denied vitiligo treatment for these two reasons:
- They valued vitiligo as a cosmetic procedure, and
- Many treatments are not FDA-approved for vitiligo, even though they may be approved for other skin conditions.
Of 17 organizations with national or regional coverage,
- 12% did not cover topical calcineurin inhibitors,
- 56% did not cover narrow-band UVB,
- 53% did not cover phototherapy with UVA, and
- 41% did not cover laser therapy.
The researchers reviewed BlueCross BlueShield policy information online or by calling the plans in 2018. They found that creams like pimecrolimus and tacrolimus were not covered in 39% and 35% of states, respectively. Narrow-band UVB and phototherapy with UVA were not covered in 20% and 10% of states, respectively. Excimer laser therapy was not covered in 82% of the states.
The researchers also gathered information from 32 states with accessible Medicaid coverage information. They relied on responses from pediatric dermatology providers in each state or open record inquiries through state Medicaid directors for coverage information. The researchers found apparent coverage gaps for many states. The coverage varied widely by state. And there were gaps in provider knowledge of what treatments are covered. They found that 11 states did not cover topicals, five did not cover narrow-band UVB, four did not cover phototherapy with UVA, and seven did not cover laser therapy.
The study’s findings above illustrate inequity in apportioning health insurance among vitiligo patients. A lack of insurance coverage for various treatments negatively affects the quality of life and healthcare outcomes of those with vitiligo. In addition, darker-skinned individuals with vitiligo are much more likely to experience stigmatization. Given that patients of color are disproportionately affected by the distribution of insurance, a call to action is made to make treatments more accessible and affordable to decrease the marginalization experienced by persons of color.
Source:
Blundell, A., Sachar, M., Gabel, C.K., & Bercovitch, L.G. (2021). The scope of health insurance coverage of vitiligo treatments in the United States: Implications for health care outcomes and disparities in children of color. Pediatric Dermatology, 38(S2), 79-85. https://pubmed.ncbi.nlm.nih.gov/34272764[/vc_column_text][/vc_column][/vc_row]
