Updates in the Treatment of Vitiligo - Episode 7

Payer Considerations for Vitiligo Treatment Coverage

Payer perspectives are considered for the treatment of vitiligo.

David Rosmarin, M.D.: Ruxolitinib cream’s approval is a game changer for our patients with vitiligo and our providers who treat it. Unfortunately, many patients who suffer from vitiligo are turned away because of our limited options. Many patients don’t have access to phototherapy. This treatment as monotherapy on its own has really good results for many of our patients. Because of its safety profile, many providers across the country are willing to prescribe this medication to help our patients out. Many providers may not be willing to use other systemic agents or may not feel comfortable with those, especially with lack of FDA approval. This is a game changer. Plus, many patients have tried other treatments, including corticosteroids and calcineurin inhibitors, and haven’t responded.

In our studies, the phase 3 patients who’ve been on phototherapy, calcineurin inhibitors, or corticosteroids did similarly well to patients who are naïve to those treatments in facial response to vitiligo. It’s helpful to know that even if patients fail those other treatments, they can still respond to ruxolitinib cream. That’s what the study shows, and that’s what I’ve seen in my practice.

Coverage for vitiligo treatments is very variable depending on the payer. There have even been some times when patient visits for vitiligo diagnosis haven’t been covered, but that’s the minority of the time. Usually our grassroots advocacy has fought back against that, and the diagnosis is almost always covered. But the treatment is very variable.

Some insurance companies wrongly consider it a cosmetic disease and lump it with all pigmentation. Some patients may have pigmentation problems for other reasons that are considered cosmetic. For instance, melasma is commonly considered to be a cosmetic disease. But vitiligo is an autoimmune disease and a medical problem. Some payers will deny calcineurin inhibitors, phototherapy, as well as other treatments. Most will allow corticosteroids because they’re very inexpensive. Now that we have ruxolitinib cream available, I expect things to change and for coverage to improve. There’s a recognition that this is truly a medical condition. There will be more grassroots advocacy as well to help advocate for patients, because it improves their quality of life and helps them.

In terms of how it affects patients, every patient is different. There are some patients who are greatly affected and some who aren’t. But in general, there’s a trend that if you have more color in your skin, you can be more affected by the vitiligo and it can be more noticeable. It’s especially true for certain cultures. For instance, Southeast Asians are very affected by the vitiligo that they have.

When payers consider coverage for vitiligo treatments, it’s important to consider value and what’s meaningful to patients. If a patient only has vitiligo on the face, there’s a recognition that it’s reasonable for a patient to try a calcineurin inhibitor first to see if that can improve the vitiligo. But after a few months, if they aren’t seeing [any improvement], then it’s reasonable to try ruxolitinib cream, which has FDA approval and has been proven to work. If a patient has body involvement, where we know the calcineurin inhibitors don’t work so well, it makes sense to go directly to ruxolitinib cream to try to improve the patients rather than making them step through treatment that we think is unlikely to help.

It’s also reasonable to try corticosteroids first on the body, as long as there’s no contraindication, but there has to be a reasonable window. And if patients have spreading vitiligo, it’s much harder to repigment patients than to halt the progression of disease. We have to be cognizant that for patients who are progressive in nature, we want to treat them urgently and not wait. It’s important to get the medicines that will be most effective approved early.

Transcript edited for clarity.