A 2023 NRS survey found that while only 3% of insurance policies covered laser therapy treatment for rosacea, more than 71% of respondents said their insurance covers some or all of their prescribed oral and topical rosacea therapy. However, a new article in the Journal of Drugs and Dermatology looked more closely at insurance coverage of topical medications for rosacea and found many of the largest insurers do not cover common, effective rosacea treatments. Moreover, even if there is coverage, it often comes with restrictions, rules and increased cost burden for the patient.

The study authors identified the top 10 American insurers by market share and then compared the topical rosacea treatments they covered. “Coverage” in this case could mean full coverage, coverage up to a quantity limit, coverage but with “step therapy” requirements (meaning other, cheaper medications must be tried first), or no coverage at all.

Only one topical medication was covered by all 10 insurers — metronidazole gel — and even then, three insurers set quantity limits on this coverage. Although topical metronidazole was the first FDA-approved therapy for rosacea over 30 years ago, treatments released since have been found to be more effective. As study author Dr. Adam Friedman, professor and chair of dermatology at George Washington University School of Medicine and Health Sciences, explained, “The findings from our study highlight that coverage is often disconnected from the evidence base.”

Of the other medications, azelaic acid was fully covered by six insurers, and three other insurers had quantity limits. Two insurers offered full coverage for ivermectin, and four had quantity limits. Four out of ten insurers offered full coverage for sulfacetamide sodium-sulfur.

“Rosacea is not a ‘one size fits all’ condition,” Friedman said. “If an insurer only covers one or two agents, clinicians may be forced to prescribe what is covered rather than what is most appropriate for the patient.”

Other newer topical therapies were covered even less frequently, with oxymetazoline only fully covered by one insurer, and minocycline foam and brimonidine only available with quantity limits from two insurers. In the case of microencapsulated benzoyl peroxide cream, no insurer offered any coverage of any kind. These newer therapies reduce facial erythema in rosacea, and Friedman considers their lack of coverage by insurers to be highly counterintuitive because “persistent facial erythema is such an essential clinical feature.”

These disparities in available treatments for rosacea highlight the difficulties many patients face in accessing effective, affordable treatment, even when they have prescription drug coverage.

“Importantly, rosacea is not merely a cosmetic condition. It is associated with significant psychosocial burden, reduced quality of life, and higher rates of anxiety and depression. When insurance coverage limits access to effective treatment, the consequences extend well beyond the skin,” Friedman concluded.

Reference:

Farah M, Zarabian N, Menta N, et al. Formulary Coverage of Topical Rosacea Therapies in United States Commercial Insurance: A Cross-Sectional Review. J Drugs Dermatol. 2026 June 1;25(6):577.