My face always seemed to flush easily. It would get really red during warm weather or when I exercised, but I had always assumed it was because I was exerting myself too much or was just out of shape regardless of whatever I was doing. I didn’t know what was going on until I learned from my dermatologist that I had type 1 (vascular) rosacea, and how I could use topical vasoconstriction medication to stop my skin from flushing. She wrote me a prescription, but my insurance company refused to fill it unless she filled out a form stating that I’d tried other medications first—including some that wouldn’t work for my rosacea type. Her plan was to fill out my insurance company’s form and send in the prescriptions to cover all of the bases.
I emailed the form to my insurance company and waited. One of my insurance company’s prescription gate keepers responded 45 minutes later to say that the doctor’s signature was illegible—have the doctor fill out the form again. When I pulled out the sheet of paper to see just how egregious my dermatologist’s signature supposedly was, I noticed I had forgotten to fill out a particularly sensitive ID number at the top of the page. Had they even looked at this form before they replied?
I quickly realized this was actually a pretty common health insurance company stalling tactic, and fumed in disbelief. They were going to regret pulling this little stunt on me; they didn’t know who they were messing with. I started typing up an unhinged email in which I called them out and legally threatened them, only to delete all of it. Instead, I opened a new message window.
I attached the exact same form, this time with the ID number filled in. I promptly received an email from a different employee stating that the form wasn’t actually necessary at all. None of this made any sense to me. Notifications began to pop up on my phone as the pharmacy filled my prescriptions.
Mirvaso’s active ingredient is found in glaucoma eye drops, brimonidine. It gave me the clammy pale lifeless pallor of a consumption patient in a Victorian tenement. My face felt cold. I unnerved myself when I caught a glance in the mirror. I had no rosacea because I had no color at all. Then came the burning: 8 hours after applying the cream to my face, it turned red and stung like a bad sunburn. I came to find out that this is what’s known as the “rebound effect.” The redness fades away after a couple of hours. It didn’t seem worth it to look gravely ill during the day and then severely sunburned in the evening.
Soolantra is the brand name for ivermectin cream. (Yes, that ivermectin.) It appeared to make no perceptual difference on my type of rosacea, but it was worth trialing because now I have a small tube of ivermectin for my own personal entertainment. Anyone snooping through my prescriptions will wonder why I need to be dewormed.
Metronidazole didn’t do anything for me, either, as it is helpful for a different type of rosacea.
Rhofade was the most expensive but also the most effective. It was the medication my dermatologist had wanted to prescribe initially, but my insurance company wouldn’t pay for it without the prior authorization. My insurance company also charged $80 for the one ounce tube—over 90% off the non-insurance price ($940).
Rhofade’s active ingredient is the same as the one found in over the counter Afrin nasal spray: oxymetazoline hydrochloride. It didn’t give me the concerning pallor or rebound issues like Mirvaso did, so at this point I almost didn’t even care about the $80 copay. Skincare can be expensive, right? At least the one ounce tube meant it was already travel-sized.
I used Rhofade for a month and then refilled my prescription. I was just happy I had found something that worked for me. My pharmacy dragged their feet for a few days before finally cancelling my order without notifying me. When I called to see why they weren’t filling it, they told me that it was on back stock and that the manufacturer was to blame. I haven’t been able to confirm this independently. My dermatologist’s office had no information and only suggested trying another pharmacy, like Amazon Pharmacy. My insurance doesn’t cover Amazon Pharmacy, nor do they offer it through their own mail order prescription program. I would have to find some other way to fill it.
But I did notice on Amazon Pharmacy that a generic has recently become available, and it would only be $670 without insurance.
