Vitiligo is Not an Orphan Disease: Current Insurance Landscape and the Ethical Case for Coverage

_{Vitiligo is a chronic autoimmune disease characterized by the progressive development of white-colored macules and patches on the skin, and its progression commonly impacts the mental health and quality of life of patients. Over 50% of vitiligo patients suffer from depression and social anxiety due to progression of the disease, and 20% of patients have other autoimmune comorbidities. Despite this, many health insurance plans do not cover the treatment of vitiligo. In this study, we assessed current vitiligo coverage policies across major health insurance companies in the U.S to determine current patterns of coverage and gaps in coverage to evaluate the financial impact on vitiligo patients. In our study sample of 20 major insurance companies in the United States, 55% do not cover laser therapy, 55% do not cover PUVA phototherapy, and 50% do not cover nbUVB phototherapy. The two most common reasons for denial of coverage was 1) vitiligo is considered a cosmetic condition and 2) certain therapies are not FDA-approved for vitiligo, though they may be approved for other skin conditions. In conclusion, 12/18 major insurance companies do not cover at least one major first-line therapy for widespread vitiligo. This lack of coverage not only worsens the financial impact and burden of vitiligo, but also further marginalizes patients with vitiligo, many of whom are patients of color.}