Is Accutane Usually Covered by Insurance?

Yes, Accutane (or the generic name, Isotretinoin) is usually covered by insurance for the treatment of acne.  In general, coverage is for severe, cystic acne or acne that has not improved with other treatments.  Most patients have to try topical agents (benzoyl peroxide, antibiotic gel, retinA) as well as oral antibiotics before insurance companies will authorize for the use of Accutane.  

If you plan to pay out of pocket, the average cost for a standard dose (30mg twice daily) is about $300-400 dollars a month.  Most patients need 5-6 months of treatment.  Keep in mind if you don't have insurance, you will also need to see you doctor and have blood test every month while you are on treatment.  This will add some additional costs.

With that said, for the right patient with severe acne, Accutane is a very effective treatment option.  I have cleared many of my patients' severe acne with Accutane.  

Best of Luck!

- Dr. Mann

Accutane (isotretinoin) is covered by most
insurance plans. If you have to pay out-of-pocket the cost will vary depending
on your dose. You will likely have to pay a couple hundred dollars per month
for 5-6 months. If you do not have insurance, you will also have to pay the lab
for your blood tests each month plus the cost of your monthly doctor visit.

I have had surprisingly few insurance problems with patients on Accutane.  Most insurances seem to cover the treatment.  A few HMO's require a few forms to be filled out.  One HMO limits the course of treatment to 5 months for some reason. 

If you have to pay out of pocket, our local pharmacies charge about $240 for 30 pills of the 20mg or 40mg dose.  Target and Walmart pharmacy where always the cheapest, but even Walgreen's has recently lowered their price.

Most insurance companies seem to cover Accutane.  As the health insurance industry is constantly changing, it's best to check with your specific plan.  The medication is now generic.  If you have to pay out-of-pocket, shop around because pharmacy prices will vary.  The cost will also depend on the brand and the dose but it will likely be a couple hundred dollars a month.  If you dont' have insurance, also consider that there will be lab test fees and doctor visits monthly for several months.

Fortunately, in the US Accutane is covered by most major insurance companies most of the time. Be sure to read the fine print when you choose your insurance though. I have had a few patients whose insurance did not provide coverage for acne. My advice is to call your insurance to see if acne is covered. Accutane can be pricey if you have to pay out of pocket, even the genetics are expensive.

Accutane is usually covered by insurance. There are, however, guidelines for coverage. In California, we frequently need to prove to some of the insurance companies that a patient has severe, cystic, scarring acne or acne that is refractory to other treatments including systemic antibiotics before they will authorize use of the medication.
We have found that in our area, if you pay out of pocket, for the standard 60 mg daily dose, it is approximately $350. Depending on body weight, most individuals require 4-6 months of therapy.

Acne is a medical condition and Accutane is FDA approved for the severe cystic type, so it is covered. The only exception would be if you had it listed as a pre-exisiting condition. There are generic substitutes now available, so the price is less than it was years ago.