3 replies to this topic

[Sammiesam]

I'm really in need of Accutane. I almost had it from my last dermatologist, but my insurance didn't cover it. I've tried everything else. I'm going to be on Medicaid soon, hoping that it'll be able to cover the cost of it, but it's considered 'cosmetic' It gets to the point where it's really messing with my mental state. Which I think should be taken into account. I e-mailed pharmacuetical companies, and most of them to not offer help for Accutane. Are there any other patient assistance programs for Accutane?

[Sammiesam]

Accutane is considered cosmetic? I had no idea. I wonder why any insurance covers it then? I know my insurance company doesn't cover anything that is cosmetic and I am on my 4th month of the medication and only paying 3 dollars a month with my insurance covering the rest. I have never seen a patient assistance program for accutane, I would doubt that there is any out there. Since it is such a debatable drug. I really hope that medicaid will cover it for you.

Wow! You're really lucky then! My previous insurance Aetna. Which covered pretty much everything, said it was cosmetic, and the only way I could get it was to pay about $700 a month for it! Ugh! Im hoping that it will cover it too.

[Green Gables]

I would fight the insurance. If they cover ANY acne conditions, they can cover Accutane. They are essentially saying that acne is only a cosmetic condition? It it is a persistent, chronic inflammation of the skin. Pus is coming out of your skin for crying out loud. Do they not cover any acne treatments at all?

They may just have a policy that they don't cover Accutane because of the expense. Accutane used to be much cheaper, but the FDA got involved because of people abusing it, and now the iPledge program associated with Accutane makes it extremely expensive. You will find that "value" insurance plans often have policies barring expensive procedures.

But it seems odd that the reason they gave you was "cosmetic." Perhaps they don't have a policy against Accutane for expense, but try to fight covering it whenever possible. You will find that in many cases you need to fight back and make them give you an airtight reason.

Unfortunately...you won't really be able to do that on Medicaid. Sorry but government health care sucks, especially Medicaid. You have no bargaining ground with gov't insurance. And Medicaid has stated that it DOES NOT cover Accutane because of the high expense of the medication.

The good news is that there are alternatives to Accutane. I see so many people who aren't cured by it anyway. Look in the Accutane forums and you'll see people on their third, fourth courses of Accutane because it didn't clear them the first time! If you're female, I would strongly recommend looking into hormonal treatment (birth control or spironolactone). You can get also get a really strong retinoid.

Edited by Green Gables, 28 June 2012 - 08:16 PM.