People who have patchy skin discoloration caused by vitiligo often experience social stigma and employment discrimination. The autoimmune disorder is also associated with a five-fold increase in risk for depression. Given these serious harms, why would some state Medicaid programs deny treatment for the condition?
It’s a reality that Representatives James P. McGovern (MA-2), Ayanna Pressley (MA-7), Stephen F. Lynch (MA-8) and Lori Trahan (MA-3) are trying to change.
An Erroneous Classification
The Congressional colleagues have penned a letter to Administrator Brooks-LaSure of the Centers for Medicare and Medicaid Services advocating that state Medicaid formularies should follow the “long-established position” that “treatments indicated for… vitiligo are NOT considered cosmetic.”
They point out that a “handful of states” are denying access to treatments “based on an erroneous classification of vitiligo as a cosmetic condition.”
Understanding Vitiligo and Treatment Options
Vitiligo is an autoimmune disorder in which the body’s defensive cells target and destroy melanocyte cells that produce melanin, the main pigment in skin, hair and eyes. This results in whitish patches on the skin.
The unpredictable progression of the disease is difficult for the four million Americans who live with the condition, but do not know how, where, or how quickly their coloration will change. Without treatment, the patches expand until vitiligo involves most of the skin.
Recently approved therapies promise more-effective symptom management for patients, including repigmentation of the skin in many cases. Unfortunately, access to those treatments often isn’t decided by providers or patients, but by insurance companies and state-run Medicaid programs.
The Human Cost of Treatment Exclusion
Formulary exclusion of vitiligo treatment compounds existing health disparities, as marginalized individuals are more likely to rely on public health plans and to experience financial barriers to medications not covered by insurance.
Vitiligo is also more noticeable in patients with darker complexions, so race correlates with greater discrimination and social stigma, even if symptoms are similar. And research shows current gaps in commercial coverage disproportionately impact children of color.
State-run Medicaid programs, tasked in large part with providing health care for those who most need assistance, should adjust their formularies to match the science of vitiligo. Correctly classifying vitiligo and ensuring access to treatment would reduce the negative impacts on patients.
