Retinoids

Started by Sparda29
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Sparda29

Sparda29

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Is there any particular reason why my insurance company refuses to cover them for me? Talking about topical retinoids here, such as Differin and Retin-A.

My dermatologist claims that I should be entitled to them until the age of 30 but my insurance company has this ridiculous thing that says I need a letter from my dermatologist and a picture of the affected area since I am over 18.

Help? I'd rather not resort to have my doctor write under my younger brothers name.
 
Sparda29 said:
Is there any particular reason why my insurance company refuses to cover them for me? Talking about topical retinoids here, such as Differin and Retin-A.

My dermatologist claims that I should be entitled to them until the age of 30 but my insurance company has this ridiculous thing that says I need a letter from my dermatologist and a picture of the affected area since I am over 18.

Help? I'd rather not resort to have my doctor write under my younger brothers name.
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thats insurance fraud and kindof a big deal.

are you close to the age of 30?
is the acne bad?
why not go to isotretinoin and get it done with quicker?
 
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Quiksilver said:
thats insurance fraud and kindof a big deal.

are you close to the age of 30?
is the acne bad?
why not go to isotretinoin and get it done with quicker?
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I am 22, acne was pretty bad but topical clindamycin along with topical salicylic acid and topical benzoyl peroxide has worked decently well.

It's just that the scarring won't go away, and I still get some acne.

Isotretinoin isn't covered either. I entered basically all of the retinoids into the system and none of them are covered.

Yeah, it is insurance fraud, which is why I'm trying to figure out a way to get this done. My doctor refuses to write out this letter or take pictures.
 
It's because they want to know that you're not using it for wrinkles. I think that's pretty reasonable since it's just a cosmetic issue and not life-threatening.
 
Acne may not be life threatening, but it sure is socially stigmatizing. I've been on Differin since I was 14 years old; that's 10 years now. I didn't realize how lucky I was to always have an insurance company that covers it. That drug is a life saver! Whoever suggested Accutane as a replacement is wrong about them being the same. I mean I guess the mechanism is, but Accutane is way more toxic. I guess it doesn't matter though because that isn't covered either. Maybe you could switch PCP's or dermatologists. Tell your current doctor that you're going to leave him because he can't help you, and find someone who possibly can. Worst case scenario, it's only $250 2-3 times a year right?
 
chibipinkbunny said:
Acne may not be life threatening, but it sure is socially stigmatizing. I've been on Differin since I was 14 years old; that's 10 years now. I didn't realize how lucky I was to always have an insurance company that covers it. That drug is a life saver! Whoever suggested Accutane as a replacement is wrong about them being the same. I mean I guess the mechanism is, but Accutane is way more toxic. I guess it doesn't matter though because that isn't covered either. Maybe you could switch PCP's or dermatologists. Tell your current doctor that you're going to leave him because he can't help you, and find someone who possibly can. Worst case scenario, it's only $250 2-3 times a year right?
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I never said it was the same. If you want to clear it up, quickly, you use isotretinoin. By the way differin does not work as well as isotretinoin. It doesn't work on all causes to acne like isotretinoin does. Isotretinoin is a hell of a drug, if you can live up with all the BS that comes along with it.

Sparda, your derm should switch up your Tx. Differin takes a year or so to clear acne vs isotretinoin which takes about 20 weeks (or less, dosed based on body weight) . Really a retinoid is first line (differin, tazorac (i think), tretinoin topical. You should really be on it if they are scarring (i'm assuming that they are the red, inflammed pimples). You might be a candidate with isotretinoin, but the drug dries every mucus membrane in your body, and chaps your lips to no end. You really should be taken off the topical clinda and put on a topical retinoid at the very least.
 
chibipinkbunny said:
Whoever suggested Accutane as a replacement is wrong about them being the same. I mean I guess the mechanism is, but Accutane is way more toxic.
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I mean, I suppose you could say part of the mechanism is the same, but isotretinoin covers all 4 mechs of acne while differin only covers 2. Far superior when it comes to clearing up the severe stuff.

It's weird the insurance company would cover a topical antibiotic but not a retinoid. Depending on the severity, retinoid and bpo are usually first line. Have you tried doxy or something else oral? It wouldnt cover the keratolytic/comedolytic mech as well as a retinoid but might be better against inflammation than topical abx.
 
aw, beat me to a response...don't you have anything better to do quiksilver...😛
 
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Quiksilver said:
I never said it was the same. If you want to clear it up, quickly, you use isotretinoin. By the way differin does not work as well as isotretinoin. It doesn't work on all causes to acne like isotretinoin does. Isotretinoin is a hell of a drug, if you can live up with all the BS that comes along with it.

Sparda, your derm should switch up your Tx. Differin takes a year or so to clear acne vs isotretinoin which takes about 20 weeks (or less, dosed based on body weight) . Really a retinoid is first line (differin, tazorac (i think), tretinoin topical. You should really be on it if they are scarring (i'm assuming that they are the red, inflammed pimples). You might be a candidate with isotretinoin, but the drug dries every mucus membrane in your body, and chaps your lips to no end. You really should be taken off the topical clinda and put on a topical retinoid at the very least.
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Ha, ha, you're right, you never said they were the same. It seemed as though you implied they were interchangeable therapies, but maybe you didn't. Anyway, if he was talking about Differin I assumed he had mild/moderate acne. If I'm not mistaken you wouldn't put someone with mild/moderate acne on Accutane unless they didn't respond to Differin, right? I'm still confused as to why you suggested he think about Accutane. Accutane is just so much more toxic that you wouldn't really consider it unless the acne was really bad. Yes, I realize that Accutane is way more powerful than Differin. That's why its used for acne that moderate/severe acne.

Oh yes, and when I said that they had the same mechanism I just meant that they were both retinoids; I assumed they were somewhat similar. I know the mechanism of Differin, but not that of Accutane. Just to clear that part up 😛
 
Sparda29 said:
Is there any particular reason why my insurance company refuses to cover them for me? Talking about topical retinoids here, such as Differin and Retin-A.

My dermatologist claims that I should be entitled to them until the age of 30 but my insurance company has this ridiculous thing that says I need a letter from my dermatologist and a picture of the affected area since I am over 18.

Help? I'd rather not resort to have my doctor write under my younger brothers name.
Click to expand...

Call your insurance company to find out why.
 
chibipinkbunny said:
Ha, ha, you're right, you never said they were the same. It seemed as though you implied they were interchangeable therapies, but maybe you didn't. Anyway, if he was talking about Differin I assumed he had mild/moderate acne. If I'm not mistaken you wouldn't put someone with mild/moderate acne on Accutane unless they didn't respond to Differin, right? I'm still confused as to why you suggested he think about Accutane. Accutane is just so much more toxic that you wouldn't really consider it unless the acne was really bad. Yes, I realize that Accutane is way more powerful than Differin. That's why its used for acne that moderate/severe acne.

Oh yes, and when I said that they had the same mechanism I just meant that they were both retinoids; I assumed they were somewhat similar. I know the mechanism of Differin, but not that of Accutane. Just to clear that part up 😛
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he implied that he has scarring indicating moderate to severe. Hes a guy and isotretinoin is far easier to give to a guy. just wrap it up for a few months
 
chibipinkbunny said:
Acne may not be life threatening, but it sure is socially stigmatizing. I've been on Differin since I was 14 years old; that's 10 years now. I didn't realize how lucky I was to always have an insurance company that covers it. That drug is a life saver! Whoever suggested Accutane as a replacement is wrong about them being the same. I mean I guess the mechanism is, but Accutane is way more toxic. I guess it doesn't matter though because that isn't covered either. Maybe you could switch PCP's or dermatologists. Tell your current doctor that you're going to leave him because he can't help you, and find someone who possibly can. Worst case scenario, it's only $250 2-3 times a year right?
Click to expand...


I'm not saying that it isn't. I've been through the whole accutane thing myself. BUT...both acne and wrinkles are cosmetic any way you look at it. It's not going to make a big difference whether you start now or next week. For that reason, I don't think it's unreasonable to ask for a prior authorization to make sure that they're not paying for someone's wrinkle cream. That's usually the purpose of a PA with retinoids....to make sure they ARE paying for acne, and not for wrinkles.
 
Yeah, I was initially started on topical clindamycin BID and oral minocycline BID, it cleared up a little then he took me off minocycline and put me on clindamycin AM, Azalex PM and benzoyl peroxide wash BID.

Same for a year, it was clear, then it got bad around October (when i started pharmacy school), so back on oral minocycline and prescribed Differin, which i never used due to PA issues.

Then i got bronchitis so i had to stop minocycline. Months past, it clears up a little.

So yeah, the PA. My doctor claims that the insurance company should have a form that they send to him and he faxes it back. My insurance company says no, he has to write a letter, and a picture of the affected area.
 
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Sparda29 said:
So yeah, the PA. My doctor claims that the insurance company should have a form that they send to him and he faxes it back. My insurance company says no, he has to write a letter, and a picture of the affected area.
Click to expand...

Well, if that's what they require, then that's what they require. His office is responsible for sending that letter in if your doctor thinks the retin-a is really necessary. Tell him you'd like the PA started.
 
Vitamin K said:
Well, if that's what they require, then that's what they require. His office is responsible for sending that letter in if your doctor thinks the retin-a is really necessary. Tell him you'd like the PA started.
Click to expand...

Yep, talked to the assistant and they said they don't write letters or take pictures. They told me to argue with the insurance company. 🙄
 
Sparda29 said:
Yeah, I was initially started on topical clindamycin BID and oral minocycline BID, it cleared up a little then he took me off minocycline and put me on clindamycin AM, Azalex PM and benzoyl peroxide wash BID.

Same for a year, it was clear, then it got bad around October (when i started pharmacy school), so back on oral minocycline and prescribed Differin, which i never used due to PA issues.

Then i got bronchitis so i had to stop minocycline. Months past, it clears up a little.

So yeah, the PA. My doctor claims that the insurance company should have a form that they send to him and he faxes it back. My insurance company says no, he has to write a letter, and a picture of the affected area.
Click to expand...

mino PO by itself isnt exactly top choice by itself and should probably only be used short term b/c of resistance, and thats a especially a big probablem with topical clinda. They would not push a PA through for Differin? damnnnn... sounds like you need both a new insurance company and doctor. topical retinoids are so mainstay and treatment of choice
 
Quiksilver said:
mino PO by itself isnt exactly top choice by itself and should probably only be used short term b/c of resistance, and thats a especially a big probablem with topical clinda. They would not push a PA through for Differin? damnnnn... sounds like you need both a new insurance company and doctor. topical retinoids are so mainstay and treatment of choice
Click to expand...

Well, one more year till I'm 23 and have to get my own insurance since I will no longer be covered under my parents plan, with my income, I'll prolly end up on Medicaid or some low-cost program. The only thing I'm afraid of with these low cost programs is that I will be forced to change my physicians into their networks.

Yeah, I might wanna change my dermatologist but I definitely don't wanna change my PCP or my Orthopedic Surgeon who is one of the best in the US, this guy immediately gets stuff done. MRI results same day or the next day, if I'm in pain, he tells me to come in immediately without an appointment and I get a methylprednisolone + lidocaine shot.
 
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accutane is a terrible drug I hope every person that recommends is immediately stricken by a case of bites-tongue for a week.
 
ThinkTooMuch said:
accutane is a terrible drug I hope every person that recommends is immediately stricken by a case of bites-tongue for a week.
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Ignorance is a terrible disease. I hope every person who speaks without knowing what they're talking about is immediately stricken by a case of shut-the-h*ll-up.
 
Are you trying to get brand name only? Or Retin-A Micro? Cause otherwise I have no idea why they wouldn't pay for a generic Retin-A cream. They're relatively cheap. When I was without insurance I bought generic tretinoin cream for like $40 cash price.

I've worked the front desk for a family practice for years and have processed hundreds, maybe thousands, of these prior-auths for outpatient pharmacy claims. I've rarely seen a problem with Retin-A, Tazorac, etc. but when it is flagged there has always been a very simply fax form where we literally just check a box saying that it's for acne (not wrinkles). In six years I've never seen a plan that required a letter and photographs from the physician's office and I think it's insane to expect/require physicians to do that. Those fax forms can be bad enough (with the time it takes to track down the right 800-numbers, wait through the holds, get your hands on the form you actually need and then search through medical records or attach copies and dig up the ICD-9 code that they want)... sometimes just those forms take a half-hour alone. A dictated letter and photographs would easily cost a physician more in time and/or staff than your insurance probably reimbursed for the visit. Sorry, but the doctors I worked for probably wouldn't do it either. And they aren't required to, unlike what someone else suggested. They would go that extra mile to get a drug that someone really needed in a life-or-death way (like certain chemo therapies or something) but not for a tube of Retin-A that you could buy yourself for well under $50.
 
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DO2Be2013 said:
Are you trying to get brand name only? Or Retin-A Micro? Cause otherwise I have no idea why they wouldn't pay for a generic Retin-A cream. They're relatively cheap. When I was without insurance I bought generic tretinoin cream for like $40 cash price.

I've worked the front desk for a family practice for years and have processed hundreds, maybe thousands, of these prior-auths for outpatient pharmacy claims. I've rarely seen a problem with Retin-A, Tazorac, etc. but when it is flagged there has always been a very simply fax form where we literally just check a box saying that it's for acne (not wrinkles). In six years I've never seen a plan that required a letter and photographs from the physician's office and I think it's insane to expect/require physicians to do that. Those fax forms can be bad enough (with the time it takes to track down the right 800-numbers, wait through the holds, get your hands on the form you actually need and then search through medical records or attach copies and dig up the ICD-9 code that they want... sometimes just those forms take a half-hour alone. A dictated letter and photographs would easily cost a physician more in time and/or staff than your insurance probably reimbursed for the visit. Sorry, but the doctors I work for probably wouldn't do it either. And they aren't required to, unlike what someone else suggested. Maybe they would go that extra mile for a drug that someone really needed in a life-or-death way (like certain chemo therapies or something) but not for a tube of Retin-A that you could buy yourself for well under $50.
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I'm trying to get Differin.
 
Have you tried a generic tretinoin? That has worked as well for me as any other retinoid. And have you looked at your formulary? Maybe Differin just isn't their preferred drug in that class, have you checked whether they would cover the brand name for anything else?
 
DO2Be2013 said:
Have you tried a generic tretinoin? That has worked as well for me as any other retinoid. And have you looked at your formulary? Maybe Differin just isn't their preferred drug in that class, have you checked whether they would cover the brand name for anything else?
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They do not cover ANYTHING in that class. The only acne meds they ever covered for me were Benzoyl Peroxide Wash, Clindamycin Gel, and Azelaic Acid Cream.
 
Before accutane, I tried both retin-a and Differin. To be honest, I think retin-a was more effective. Definitely more side effects though as well. I'm using Differin post-accutane right now and while I do think it's helping my skin (overall texture), the retin-a caused sloughing kind of like accutane does and that seems like it would be more helpful in achieving clear skin than what I'm getting from the Differin. This one is pure opinion, but it might be worth it to pay cash for retin-a for a while to see if it's worth all this hassle to you.
 
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