Insurance Claims and Prescriptions for Rosacea vs Melasma

African American black woman female patient with White doctor
African American black woman female patient with White doctor
Insurance coverage for topical treatments for rosacea vs melasma are investigated.

Patients with rosacea make significantly more insurance claims and are more likely to access their treatment prescriptions compared with patients with melasma, researchers reported in a study published in the British Journal of Dermatology.

The study authors retrospectively assessed the rate of insurance coverage for first-line topical treatments for rosacea compared with melasma. They used data from a commercial database from 2016 to 2018, which included health insurance claims and enrollment data from large employers and health plans in the United States that provide private health care for more than 43.4 million people.

The rosacea group included patients with International Classification of Disease version 10 (ICD-10) codes for rosacea and without codes for acne or perioral dermatitis. The melasma group included patients with ICD-10 codes for melasma and without codes for postinflammatory hyperpigmentation, vitiligo, Addison’s disease, or solar lentigines. The study authors extracted claims for topical formulations of metronidazole and hydroquinone for rosacea and melasma treatment, respectively, excluding oral formulations.

A total of 353,866 adult patients aged 18 years and older were included—308,907 with rosacea and 44,959 with melasma. Of the patients whose sex was known, in the rosacea group there were 211,585 women and 97,111 men; in the melasma group there were 780 women and 47 men.

The patients with rosacea made significantly more claims per person on average (1.86 [SD 1.78] vs 1.59 [SD 1.39], P < .0001) and were significantly more likely to access their treatment prescriptions compared with melasma patients, it was noted.

A total of 101,704 patients with rosacea (32.24%) obtained a prescription, compared with 827 patients with melasma (1.84%) who obtained a prescription. The unadjusted odds ratio (OR) of obtaining prescriptions for rosacea vs melasma was 26.22 (24.46-28.09), and the age-adjusted OR of obtaining prescriptions for rosacea vs melasma was 27.00 (16.636-43.84).

“This suggests that first-line treatments for melasma may be less frequently covered by insurance than those for rosacea, thus preventing darker-skinned patients from accessing appropriate health care,” the study authors commented. “Only private insurance was captured in our database, which may magnify the gap; however, it is unlikely to be fully responsible for such a significant disparity.”

Several study limitations were noted, including the lack of data on race, public insurance plans, and noncost factors that are a barrier to prescription access.

“Future studies should probe this coverage gap more thoroughly and include alternative forms of treatment, such as laser therapy,” stated the researchers. “They should also explore how taxpayer-funded health care systems may block melasma care in different ways, like referral for consultant access.”


Sun H, Lim JS, Silva, CF, Maczuga SA, Hollins LC. Insurance coverage gap for treatment of melasma compared to rosacea: it pays to be light. Br J Dermatol. Published online July 13, 2021. doi:10.1111/bjd.20641