Six insurers, six rulebooks, and a denial letter that names none of them

Aetna covers narrow-band UVB, including a home unit, for both conditions. Topical treatment has to fail first. For vitiligo, that means trying at least one of three things: topical Protopic (tacrolimus), a topical or systemic corticosteroid, or topical Opzelura (ruxolitinib). Aetna added the home-unit option to this vitiligo policy in July 2026. For psoriasis, PUVA requires severe disease: 10% or more of the body, or the hands, feet, or scalp. Home UVB for psoriasis is for frequent flares when in-office sessions are not possible.⌁ Evidence⌁ Evidence⌁ Evidence

• Vitiligo: inadequate response to topical Protopic (tacrolimus), topical/systemic corticosteroids, or topical Opzelura (ruxolitinib) required first.
• Vitiligo: continued PUVA or home UVB stays medically necessary only if some follicular pigmentation shows up within six months.
• Psoriasis: PUVA requires 10%+ body surface area, or hand/foot/scalp involvement, after conventional therapy has failed.
• Psoriasis: continued treatment stops being considered necessary if there is no improvement within two months.

UnitedHealthcare's "Light and Laser Therapy" medical policy is effective January 2026. It does not name psoriasis or vitiligo anywhere in its coverage rationale. It sets rules for other light and laser procedures instead: pulsed dye laser for port-wine stains and hemangiomas, laser treatment for burn scars and pilonidal sinus disease. It states phototherapy is unproven for acne, onychomycosis, rhinophyma, and rosacea by name.⌁ Evidence

• Covered by this specific policy: pulsed dye laser for port-wine stains or hemangiomas, laser for certain burn scars, and laser hair removal tied to pilonidal disease.
• Stated unproven by this policy: light phototherapy, photodynamic therapy, and IPL for acne, onychomycosis, rhinophyma, and rosacea.
• Not mentioned anywhere in this policy: psoriasis, vitiligo.

Blue Cross Blue Shield is not one company. It is a group of independent local companies, each writing its own medical policy. Premera Blue Cross is the one for Washington. Premera covers home UVB light therapy for a named list of conditions, including psoriasis and vitiligo. The condition must be severe. It must have resisted other treatment for more than four months.⌁ Evidence

• Condition must be severe, extensive, and refractory for more than four months.
• Treatment needed several times a week, on a long-term maintenance basis.
• Device must be FDA-approved, UVB-only, and prescribed by a dermatologist.
• Member must be able to operate the device, and either unable to travel for office-based therapy or home therapy must be more cost-effective.

Cigna removed prior restrictions on home phototherapy coverage, effective July 15, 2025. This opened access for members with psoriasis, eczema, and vitiligo. That description comes from an announcement distributed by Phothera, a home-phototherapy device maker, not from Cigna itself. Cigna’s own general patient page on phototherapy for psoriasis mentions home treatment as a possibility, without stating a coverage rule.⌁ Evidence⌁ Evidence

• Policy change: home phototherapy restrictions removed, effective 7/15/2025, per the device-maker announcement.
• Cigna's own patient page (last reviewed December 2024): mentions home treatment as possible, states no specific criteria.

Kaiser Foundation Health Plan of Washington covers excimer laser for psoriasis of the scalp, face, neck, or hands, after two topical treatments have failed over 12 weeks. For vitiligo of the face, neck, or hands, it requires both a topical corticosteroid and a topical calcineurin inhibitor to have failed over at least 12 weeks. Home narrowband UVB is covered for qualifying conditions when a dermatology provider orders it.⌁ Evidence

• Excimer laser, psoriasis: scalp, face, neck, or hands. Two topicals from a named list must have failed over 12 weeks.
• Excimer laser, vitiligo: face, neck, or hands. Both a topical corticosteroid and a topical calcineurin inhibitor must have failed over 12+ weeks.
• Home narrowband UVB: covered when dermatology-ordered and the member has durable-medical-equipment coverage.
• Not covered, stated explicitly: tattooing, depigmentation, and melanocyte transplant for vitiligo, as cosmetic.

Medicaid is not one program. Each state runs its own within federal rules. One example: AmeriHealth Caritas Louisiana, a Louisiana Medicaid managed-care plan, covers office-based UVB and PUVA for psoriasis and vitiligo after conventional therapy has failed. It covers home UVB only for severe, extensive, long-resistant disease treated several times a week, when the member cannot travel for office care. It does not cover home PUVA at all.⌁ Evidence

• Office-based UVB, UVB narrowband, and PUVA: covered for a named list of conditions including psoriasis and vitiligo, after conventional therapy fails.
• Home UVB: covered only when severe, extensive, refractory 4+ months, needing several treatments a week, and the member cannot travel for office-based care.
• Home PUVA: not covered under any circumstance in this specific plan.