For immediate release (May 22,1998)
Dermatologists at Wake Forest University Baptist Medical Center
Recommend Raising Age for Insurance Coverage for Acne Drugs To Age 40 -- or Beyond
WINSTON-SALEM, N.C. -- Insurance companies that limit payment for the acne drug tretinoin to teen-agers and young adults are leaving thousands of Americans who suffer adult acne to pay for treatment themselves or do without, according to two dermatologists at Wake Forest University Baptist Medical Center.
In a report published in the Journal of the American Academy of Dermatology, Drs. Steven Feldman and Alan Fleischer recommend raising the age for insurance coverage of the drug to at least 40.
"We found that many insurance companies refuse to pay for tretinoin for patients older than 25," said Feldman, associate professor of dermatology and pathology.
Tretinoin, sold under the brand names Retin-A and Renova, is effective in treating not just acne but also sun-damaged skin. Fleischer, associate professor of dermatology, said that because many insurance companies do not pay for cosmetic services, they cut off coverage of tretinoin in the belief that acne is mostly an affliction of teens and young adults.
In some cases, Feldman said, insurance companies may cover tretinoin prescriptions for adults over the cut-off age, but only if their doctor gets pre-authorization from the company to issue the prescription.
Feldman and Fleischer undertook their study to give insurance companies a more rational basis for setting age criteria for tretinoin coverage.
They studied data on visits to the doctor gathered as part of the National Ambulatory Medical Care Survey for 1990 through 1994 to determine the ages of people who visited a doctor for acne and who were treated with tretinoin. They compared this with the ages of people who received prescriptions after visiting the doctor because of wrinkles or other sun-induced skin damage.
"We found that even among people age 33, 75 percent of tretinoin prescriptions were for acne," Feldman said. "And at age 40, 63 percent of the prescriptions still were for acne. Prescriptions for acne did not balance with those for photoaging and other skin conditions until the age of 46.6."
Given this data, Fleischer said, "We concluded that the cut-off, if used, should be at least 40 years."
The study was published in the February issue of the Journal of the American Academy of Dermatology. In a follow-up study now under way, Feldman and Fleischer are hoping to identify the most cost-effective cut-off age based on the cost of the drug, the cost of requiring pre-authorization for tretinoin prescriptions, and the age distribution of tretinoin prescriptions for acne and non-acne conditions.
According to the American Academy of Dermatology, acne is the most common skin problem in the United States, affecting up to 80 percent of people in their 20s and 30s. While acne is often triggered by hormonal changes during pre-teen years, many cases are adult onset, often caused by hormonal changes during pregnancy or as a result of irregularities in the menstrual cycle.
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Contact:Mark Wright, Jim Steele or Robert Conn at 336-715-4587
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