Why Is Arestin Not Covered by Insurance?

Why Is Arestin Not Covered By Insurance

Arestin is an antibiotic treatment for periodontal disease (gum infection) that is applied directly into the infected gum pockets by a dental professional. It is used as an adjunct to scaling and root planing (SRP), a procedure that removes plaque and tartar from the teeth and their roots.

Arestin is not covered by insurance due to various reasons, including limited evidence of long-term efficacy and cost-effectiveness. Dental insurance policies often prioritize coverage for preventive and essential treatments, which results in limited coverage for adjunctive procedures like Arestin. Additionally, Arestin is FDA-approved only for periodontal disease, and if the condition is not covered by the insurance plan, the medication will not be covered. Some insurance plans may classify periodontal disease treatment as a cosmetic procedure, which is typically not covered by insurance.

However, you may be eligible for a copay as low as $0 if your medical insurance prescription plan provides coverage for Arestin. You can also talk with your dental office about other options that may make paying for your prescription easier.

Periodontitis, also known as gum disease, affects millions of people worldwide. It is a chronic inflammatory condition that can lead to tooth loss and other serious health complications if left untreated. Arestin is an antibiotic treatment used in conjunction with scaling and root planing to manage periodontitis.

However, many patients are surprised to find out that Arestin may not be covered by their insurance, leaving them with the burden of paying out-of-pocket for this essential treatment.

One common objection to why Arestin may not be covered by insurance is the cost-effectiveness of the medication compared to other treatments. Insurance companies typically base their coverage decisions on the cost-benefit ratio of a given medication or treatment. If they determine that Arestin does not provide significant benefits over other available treatments at a similar or lower cost, they may choose not to cover it.

In this article, we will explore the reasons why insurance companies may choose not to cover Arestin and what options are available for patients who require this important treatment option.

Understanding Arestin and Its Role in Treating Periodontitis

The treatment of periodontitis involves the administration of a special antibiotic agent that is applied directly to the infected gums, reducing bacterial growth and inflammation while promoting healing. Arestin is one such antibiotic agent that has been developed specifically for this purpose. It is a locally-administered minocycline microsphere that can be easily applied to the gum pockets using a syringe-like applicator.

Once administered, Arestin slowly releases minocycline into the surrounding tissue, killing bacteria and reducing inflammation over time. Arestin efficacy has been extensively studied in clinical trials and has shown promising results in treating periodontitis. In these studies, patients receiving Arestin treatment experienced significant reductions in pocket depth and bleeding on probing compared to those who did not receive any treatment or received placebo treatments.

Additionally, Arestin was found to be effective even when used as an adjunct therapy along with scaling and root planing procedures. However, despite its proven efficacy, many insurance providers do not cover the cost of Arestin treatment due to its higher cost compared to other antibiotics commonly used for periodontal disease management.

How Insurance Companies Determine Which Medications to Cover

Insurance companies use a complex process to determine which medications are included in their coverage. These decisions are based on various factors such as the drug’s effectiveness, safety, and cost-effectiveness.

Insurance companies create drug formularies that list the medications they will cover for specific conditions. Formularies can vary between insurance plans and may be updated regularly.

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When considering whether to include a medication like Arestin in their coverage, insurance companies evaluate its clinical efficacy and safety compared to other treatments for the same condition. They also consider the costs associated with the medication, including its manufacturing expenses, distribution costs, and any rebates or discounts offered by manufacturers.

If a medication is deemed too expensive or has limited clinical evidence of effectiveness, it may not be included in an insurance plan’s formulary. However, patients who feel that Arestin is necessary for their treatment can still obtain it through paying out-of-pocket expenses.

Reasons Why Arestin May Not Be Covered by Insurance

The limited coverage for dental procedures may be a reason why Arestin is not covered by insurance.

Additionally, there is a lack of clinical data on the effectiveness of Arestin, which could also contribute to its exclusion from insurance coverage.

Cost-effectiveness considerations may further compound these issues and lead to Arestin being excluded from insurance plans.

Limited Coverage for Dental Procedures

Dental insurance plans are known for their coverage limitations when it comes to certain procedures, including Arestin treatment. While some insurance providers may cover a portion of the cost, others may not offer any coverage at all. This can result in higher out-of-pocket costs for patients who require this antibiotic treatment for gum disease.

The limited coverage for dental procedures is due to a variety of factors, including the type of plan that patients have and the specific benefits included in their policy. Some dental insurance plans prioritize preventative care, such as regular cleanings and check-ups, over more complex treatments like root canals or periodontal therapy with Arestin.

Additionally, even if a plan does cover Arestin treatment, there may be limits on the number of applications per year or restrictions on which teeth are eligible for treatment. As a result, many patients find themselves paying out-of-pocket expenses when seeking this important form of periodontal care.

Lack of Clinical Data on Arestin’s Effectiveness

Studies on the effectiveness of certain antibiotic treatments for gum disease have yielded conflicting results, leaving uncertainty about their true impact on patients’ oral health. For example, a recent study found that while some participants experienced significant improvements in periodontal measures after receiving antibiotics, others showed no change or even worsened conditions (source: Journal of Periodontology).

These data limitations have made it difficult for insurance companies to justify covering certain antibiotic treatments, including Arestin. Additionally, regulatory issues surrounding the use of antibiotics in dentistry have further complicated matters.

Despite these challenges, there is still ongoing research into the effectiveness and safety of Arestin as a treatment for gum disease. Some studies suggest that when used in conjunction with scaling and root planing procedures, Arestin can significantly improve periodontal outcomes. However, until more consistent and reliable clinical data is available to support its use, insurance coverage for Arestin may remain limited.

Cost-Effectiveness Considerations

Cost-effectiveness considerations play a significant role in determining the widespread adoption and utilization of certain antibiotic treatments for gum disease, which can have implications on both patient outcomes and healthcare costs. While Arestin has been shown to be effective in treating periodontitis, it is not covered by insurance plans due to its high cost. Patients who opt for Arestin treatment may need to pay out-of-pocket expenses, which can limit its accessibility and affordability.

To illustrate the cost differences between Arestin and other commonly used antibiotics for gum disease treatment, we present a comparison table below. The table shows that while Arestin has a higher unit cost than other antibiotics, it requires only one application compared to multiple doses of other antibiotics. This means that the total cost of treatment with Arestin may actually be lower than that of multiple doses of other antibiotics over time. However, insurance companies may still consider the initial high unit cost as a deterrent to covering this type of antibiotic treatment for periodontitis patients. Ultimately, patient affordability plays a crucial role in determining whether or not they will choose an antibiotic treatment option like Arestin over others that are more affordable but may require more applications over time.

Antibiotic TreatmentUnit CostNumber of Applications NeededTotal Cost
Arestin$300-400 per tooth1 application every 3 months (up to 3 times) per tooth$900-$1200 per tooth
Doxycycline Gel (Atridox)$85-125 per syringe (contains enough gel for 5 sites)1 syringe needed per site; up to 2 sites treated at each appointment; typically given twice during therapy; repeated once during maintenance phase every three months as needed; up to six treatments needed overall with two visits necessary for each treatment session ($170-$250 per visit)$1020-$1500 per tooth
Minocycline Microspheres (Arestin)$75-125 per syringe (contains enough microspheres for 15 sites)1 syringe needed per site; up to 2 sites treated at each appointment; typically given twice during therapy; repeated once during maintenance phase every three months as needed; up to six treatments needed overall with two visits necessary for each treatment session ($170-$250 per visit)$900-$1350 per tooth

Options for Paying for Arestin Treatment

Payment possibilities for the administration of this adjunctive therapy may involve personal financial resources or public health programs.

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Financing options for Arestin treatment include private insurance, Medicaid, Medicare and out-of-pocket payments. However, Arestin is not covered by most insurance companies as it is considered a non-essential dental procedure that can be avoided with proper oral hygiene practices. This poses a challenge for patients who require Arestin treatment but cannot afford to pay out of pocket.

Patient assistance programs are available to help offset the cost of Arestin treatment. The manufacturer of Arestin offers a savings program that provides eligible patients with up to $50 off their co-payments per prescription. Additionally, some dental offices offer financing plans or payment arrangements to help patients manage the cost of their treatment over time. Patients can also consider seeking treatment at dental schools or clinics that offer reduced rates or sliding scale fees based on income level.

Despite the challenges in paying for Arestin treatment, there are options available to make it more accessible and affordable for those who need it most.

Advocating for Coverage of Arestin

This subtopic focuses on advocating for coverage of Arestin, a periodontal disease treatment that is not covered by insurance.

The discussion will cover three key points:

  • Appealing coverage decisions
  • Working with your dentist and insurance provider
  • Joining patient advocacy groups.

By following these strategies, patients can increase their chances of obtaining insurance coverage for Arestin treatment.

Appealing Coverage Decisions

One potential strategy to obtain coverage for certain medical treatments involves appealing coverage decisions made by insurance providers. When insurance denials occur, patients have the right to appeal the decision and request that their treatment be covered.

The appeal process typically requires documentation from healthcare providers, including medical records and justification for why the treatment is necessary.

Appealing coverage decisions for Arestin may require additional effort due to its classification as a dental procedure rather than a medical one. Insurance companies often have separate policies and criteria for covering dental procedures, which can make it challenging for patients seeking coverage for Arestin.

However, with proper documentation and support from healthcare providers, patients may still be able to successfully appeal coverage denials and receive the necessary treatment.

Working with Your Dentist and Insurance Provider

Collaborating with dental professionals and insurance providers can be a productive approach for patients seeking to secure coverage for necessary dental treatments. When it comes to Arestin, the process of securing coverage may require dentist negotiation and filing an insurance claim.

While some insurance providers do not cover Arestin, others may offer partial or full coverage depending on the patient’s specific policy.

To begin the process of securing coverage for Arestin treatment, patients should first consult with their dental professional about their insurance policy’s coverage options. Dental professionals can provide valuable information regarding the specifics of a patient’s policy and negotiate with insurance providers on behalf of their patients.

Additionally, filing an insurance claim may be necessary to obtain reimbursement for any out-of-pocket expenses associated with Arestin treatment. Patients should work closely with their dental professional to ensure that all necessary documentation is submitted accurately and in a timely manner to expedite claim processing and secure maximum benefits through their insurance provider.

Joining Patient Advocacy Groups

Participating in patient advocacy groups can provide valuable resources and support for individuals seeking to navigate the complexities of dental treatments and insurance coverage. These groups offer a space where participants can share their experiences, learn from others, and gain knowledge about various aspects of dental care. Through these interactions, patients may develop a better understanding of why certain treatments are not covered by insurance or how to advocate for themselves when dealing with insurance companies.

Patient support is an integral aspect of advocacy strategies employed by these groups. Advocacy strategies typically involve educating patients on their rights, helping them identify alternative sources of funding for dental procedures that are not covered by insurance, and providing guidance on how to communicate effectively with insurers and healthcare providers.

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Additionally, advocacy groups work towards creating awareness among policymakers about issues related to access to affordable dental care and insurance coverage. By joining such patient advocacy groups, individuals can find support in navigating the complex world of dental care and insurance while also advocating for policy changes that could improve access to affordable dental care for all.

Frequently Asked Questions

What is the cost of Arestin treatment without insurance coverage?

Arestin treatment is a non-surgical procedure used to treat periodontal disease. Cost and accessibility are two significant factors that affect the decision of patients to undergo this treatment.

The cost of Arestin treatment without insurance coverage varies depending on the region, but it can be relatively expensive compared to other treatments for periodontal diseases. Despite its effectiveness, Arestin may not be accessible in some regions due to limited availability or lack of trained dental professionals who can administer the treatment.

Therefore, patients should consider their financial situation and accessibility when deciding whether or not to pursue Arestin treatment as a viable option for treating their periodontal disease.

Are there any alternative treatments for periodontitis that are covered by insurance?

Periodontitis is a chronic inflammatory disease that affects the supporting tissues of teeth. Currently, there are several treatment options available for this condition, including traditional scaling and root planing (SRP) and surgical interventions. However, some individuals may prefer natural remedies for periodontitis due to concerns about potential side effects associated with conventional treatments.

There is limited scientific evidence to support the effectiveness of natural remedies in treating periodontitis, but some studies suggest that certain herbs and supplements may have anti-inflammatory properties that could help reduce gum inflammation and promote healing. While insurance coverage for these alternative treatments may vary depending on the provider and policy, it is worth discussing with your healthcare provider if you are interested in exploring these options as part of your periodontal care plan.

Can insurance coverage for Arestin vary depending on the type of insurance plan?

Insurance coverage for arestin may vary depending on the type of insurance plan. For instance, some dental insurance plans may cover a portion of the cost of this treatment while others may not provide any coverage at all. The variation in insurance coverage is often determined by the specific terms and conditions outlined in each individual policy.

Despite its effectiveness in treating periodontitis, arestin may not be covered by certain insurance plans due to its perceived high cost or lack of inclusion in their formularies. As such, patients should consult with their dental care provider and insurer to determine if they have coverage for this treatment option and how much they can expect to pay out-of-pocket.

How effective is Arestin in treating periodontitis compared to other treatments?

Periodontitis is a common inflammatory disease that affects the supporting structures of teeth. There are several treatment options available for this disease, including scaling and root planing (SRP), local delivery of antimicrobial agents like Arestin, and systemic antibiotics.

The effectiveness comparison between these treatment modalities has been extensively studied in various clinical trials. According to these studies, SRP alone or in combination with systemic antibiotics provides more significant benefits than Arestin therapy alone. However, the use of Arestin as an adjunct to SRP has shown some additional improvements compared to SRP alone.

While Arestin therapy is generally well-tolerated by patients, it can cause minor side effects such as pain and sensitivity at the site of application. Further research is needed to determine the most effective treatment approach for periodontitis based on individual patient needs and preferences.

Are there any patient assistance programs available to help with the cost of Arestin treatment?

There are patient assistance programs available to help with the cost of Arestin treatment.

Patient eligibility for these programs varies by organization, but generally targets individuals who are uninsured or underinsured with limited financial resources.

The application process typically involves completing an application form, providing proof of income and insurance coverage, and submitting it to the specific program for review.

Some organizations may also require additional documentation such as a physician’s statement or prescription.

It is recommended that patients explore all available options and research each program’s eligibility requirements before applying.


In conclusion, Arestin is a valuable medication in the treatment of periodontitis. However, insurance coverage for this medication varies depending on several factors such as cost-effectiveness and FDA approval. Patients who are not covered by their insurance can explore other payment options such as discount programs or negotiating with their dentist.

Advocating for coverage of Arestin may also be an option for patients who believe they would benefit from the medication but cannot afford it. While navigating insurance coverage for medications can be frustrating, it is important to remember that there are always alternative options available.

As the saying goes, ‘where there’s a will, there’s a way.’ It is up to patients and healthcare providers to work together to find the best possible solution for treating periodontitis and improving oral health outcomes.

Why Is Arestin Not Covered by Insurance?