A few months ago, I walked into a doctor’s office prepared to do the same thing I’ve done dozens of times before over the last 27 years: tell the doctor I have acne. I would review the list of every topical medication and oral antibiotic I’ve used to treat it. He would prescribe a regimen, I’d follow it to the letter, and I’d be on my way to clearer skin.
Only this time, things didn’t go exactly as I expected.
The dermatologist recommended putting me on two topical medications to start out. I don’t like routinely taking oral antibiotics, so trying the least invasive method available was fine with me. Not surprisingly, one of the medications was a retinoid. I’ve used Retin-A, Differin, and many other variations on the retinoid theme to successfully treat my moderate to severe acne since my teens.
I dropped off the prescriptions at the pharmacy and waited for the call that they were ready to be picked up.
Two days later, the pharmacy called to tell me that my prescription for the retinoid was not going to be covered by my PPO insurance.
I was perplexed. I’d never had an insurance company deny prescribed medicine for acne before.
“Do you know why they’ve refused to cover the medication?” I asked the pharmacist.
“You’re 43. The insurance company doesn’t cover this medication for anyone over the age of 35. Their stance is that if you’re over 35 and using this product, it’s for cosmetic purposes – to treat wrinkles.”
Apparently, I’m too old to have acne.
“How much is the medication if I pay for it in full?” I asked.
The pharmacist seemed almost embarrassed. “It’s $370 for one tube, which will last you a month.”
Apparently, I’m also too poor to treat the acne I’m too old to have.
But I know I’m not alone. Every time I get together with girlfriends, somebody expresses frustration over her adult acne.
Many people are turning to natural remedies when they find their insurance company won’t pay for “cosmetic” medications – things like honey, bananas, and apple cider vinegar. Others are trying to make dietary changes to limit acne outbreaks.
As for me, we happen to be changing insurance companies next month. I’m anxious to learn whether our new insurance might cover retinoid treatments for acne or whether it, too, will have determined that I am simply too old for acne.
Have you encountered difficulties with insurance coverage on medications that are used both for medical and cosmetic reasons? How did you handle it?
Gigi Ross is a mom of two spunky school-aged children in San Diego, CA and works as a freelance writer and social media consultant. She keeps her personal blog at KludgyMom, a snappish take on parenting and pop culture.