Is Accutane Covered by Insurance?

Health Insurance

If you’re reading this blog post you’re probably ready to start taking Accutane or at least you are seriously considering Accutane as the best treatment for your acne.

Because Accutane is the most effective treatment for almost all forms of acne, many acne sufferers ultimately end up at least thinking about Accutane as a real possibility, often after using many other acne treatments without experiencing improvement.

Most commonly, treatments including topical medications, over-the-counter products, antibiotic pills, chemical peels, facials and a variety of others are tried before turning to Accutane.   This is because many think of Accutane as a treatment of “last resort.”

One of the common questions that acne sufferers have is whether Accutane is covered by insurance.  The answer to this question is “yes”… and “no.”  The reason for the contradictory answers is because some insurance companies cover Accutane readily whereas others may require “prior authorization” while still others may not cover Accutane at all.  It all depends on your particular insurance plan.

Some Plans Require Prior Authorization

For those plans that cover Accutane right from the start, treatment can begin without delay.  This is the case with most of the plans that are encountered.  However, a significant number of plans require “prior authorization” in which certain requirements must be met in order to obtain insurance coverage.

Some insurance plans require that an acne sufferer first try certain topical medications and/or certain oral antibiotics before allowing coverage for Accutane.  For example, using one or more topical medications usually including benzoyl peroxide or containing derivatives of vitamin A, also called “retinoids,” is typical of the topical medications that are required.

Sometimes these must be used in combination for a specified period of time depending on each insurance company.  Also, it is common for prior authorizations to require that the topical medications are used in combination with particular oral antibiotics, most commonly in the tetracycline family such as doxycycline or minocycline for example.  Using this combination is often required for up to 2 months, even if no improvement is achieved, before Accutane will be covered.

In some cases, even if the prior authorization is approved, it is often only approved for a specific period of time.  While the time allotted is usually sufficient to complete treatment with Accutane, some patients need a longer duration of treatment than the standard time. This can occur for a variety of reasons, including for medical reasons in some patients who need an adjustment in the standard treatment course. When this occurs, it is usually necessary to obtain another prior authorization from the insurance company which can interrupt treatment progress.

When a requirement for a prior authorization is encountered, initiation of Accutane can be significantly delayed.  Receiving an answer to the completed prior authorization form can sometimes take many days.  If initially denied, there are usually options to appeal the decision but that can often take an even greater time to complete.

This process can be very frustrating to an acne sufferer who is already experiencing significant frustration and emotional consequences of acne breakouts.  And if the prior authorization is ultimately denied after going through the lengthy process, the only remaining options are to either follow the requirements of the prior authorization and first utilize the other specified topical and oral medications and show that they are not effective, or purchase Accutane without insurance.

Purchasing Accutane Without Insurance

In the past, purchasing Accutane without insurance was very expensive and often cost-prohibitive for most patients.  However, today it is often more affordable.  There are currently multiple generic versions of Accutane and some pharmacies have very reasonable prices.

Many acne sufferers prefer to pay out-of-pocket for Accutane rather than continue to delay treatment while awaiting compliance with a lengthy prior authorization process. Using a pharmacy discount card or finding a pharmacy with the most affordable prices can help to minimize the cost of treatment as well as preventing a long delay in initiation of Accutane therapy caused by lack of affordability.

The Advanced Acne Institute is a unique dermatology practice located in Miami, Florida specializing only in the treatment of acne.   We focus solely on providing the most effective treatments to help our patients achieve clear skin.  We are pleased to share our insights and perspectives in acne treatment as an educational service, however this information is provided strictly for educational purposes only and should not be considered medical advice and is not a substitute for seeking the advice and treatment by an appropriate medical professional.