CurrentCignaPolicy IP0785

Topical Alpha Adrenergic Agonists for Rosacea - Rhofade

Cigna coverage policy addressing use of oxymetazoline hydrochloride 1% topical cream (Rhofade) for persistent facial erythema associated with rosacea in adults, stating the product is considered not medically necessary and cosmetic under the plan.

Policy Summary

PayerCigna

PolicyTopical Alpha Adrenergic Agonists for Rosacea - Rhofade

Policy CodePolicy IP0785

Change TypeNew Policy

Effective DateMar 15, 2026

Next Review Date

Key ActionClaims billed for oxymetazoline (Rhofade) to treat persistent facial erythema associated with rosacea will be denied as not medically necessary/cosmetic under this policy; submit only covered diagnosis/procedure codes to avoid denial.

SourceLink

POLICY UPDATE CHANGES

New policy created (Annual Revision, Summary of Changes = New Policy).

1Primary Product Addressed

0Covered Indications

1Not Medically Necessary Indications

Coverage Summary

Cigna coverage policy addressing use of oxymetazoline hydrochloride 1% topical cream (Rhofade) for persistent facial erythema associated with rosacea in adults; the policy stance is not_covered_cosmetic for this indication. Policy number: IP0785. Payer: Cigna Companies. Effective date: 03/15/2026. Status: CURRENT.

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Medical Necessity / Coverage Criteria

Not Covered / Not Medically Necessary

Oxymetazoline (Rhofade) for the treatment of persistent (nontransient) erythema associated with rosacea is considered not medically necessary.

ALL of the following

Patient has persistent (nontransient) facial erythema associated with rosacea
Use of topical oxymetazoline (oxymetazoline hydrochloride 1% cream, Rhofade) to treat erythema
Treatment is performed solely to alter appearance (cosmetic) or address self-esteem/psychosocial complaints related to appearance

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title":"Not Covered / Not Medically Necessary"}

Not Covered — Cosmetic

Rhofade is indicated in the label for topical treatment of persistent facial erythema associated with rosacea in adults but is explicitly not indicated for inflammatory lesions. The policy rationale states that treatment of untoward cosmetic effects of rosacea (for example: erythema, telangiectasia) is considered cosmetic in nature and therefore not medically necessary under many benefit plans when performed solely to alter appearance or address self-esteem/psychosocial complaints.

Provider Actions / Billing Impact

Denial Risk

Claims for Rhofade for persistent erythema of rosacea

Claims billed for oxymetazoline (Rhofade) to treat persistent facial erythema associated with rosacea will be denied as not medically necessary/cosmetic under this policy; submit only covered diagnosis/procedure codes to avoid denial.

Submit only covered diagnosis/procedure codes to avoid denial

Documentation Required

Benefit plan and medical necessity review

Coverage determinations require review of the member's specific benefit plan document, applicable laws/regulations, and relevant clinical information; medical directors may exercise clinical judgment for individual cases.

Background & Evidence

Rhofade (oxymetazoline hydrochloride 1% topical cream) is labeled for the topical treatment of persistent facial erythema associated with rosacea in adults. The policy interprets pharmacologic treatment of erythema and other untoward cosmetic effects (e.g., telangiectasia) as cosmetic and not medically necessary under many plans; the label specifically notes Rhofade is not indicated to treat the inflammatory lesions of rosacea.

Source	Citation
Manufacturer prescribing information	Rhofade topical cream [prescribing information]. Charleston, SC: EPI Health; May 2023.
Guideline	Del Rosso JQ, Tanghetti E, Webster G, et al. Update on the management of rosacea from the American Acne & Rosacea Society (AARS). J Clin Aesthet Dermatol. 2020;13(6):17-24. Topical alpha-agonists are pharmacologic options for centrofacial erythema without papulopustular lesions; typically reduce facial erythema within 30–60 minutes with peak benefit ~3–4 hours.

Persistent (nontransient) erythema: Facial redness associated with rosacea that is ongoing rather than transient/flushing (policy does not provide a numeric threshold).