January 14, 2010

Proposed Medicare Coverage for Facial Wasting Treatment

Medicare administrators are offering a proposal to use approved injectable fillers to treat people with HIV who have facial wasting—but only if they provide proof that their facial wasting lead to depression. People may send public comments to Medicare officials on this proposal until January 22.

Facial wasting (lipoatrophy) is primarily a side effect of certain antiretroviral (ARV) drugs—predominantly Zerit (stavudine) and Retrovir (zidovudine). Though people taking these drugs can generally halt facial wasting by switching to other ARVs, the condition is not usually reversible.

The U.S. Food and Drug Administration (FDA) has approved two fillers to treat HIV-related facial lipoatrophy: Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite). Both fillers are only temporary and have to be readministered, however, and are not currently covered by government insurance programs such as Medicare and Medicaid.

Last year, the Medicare administration issued a call for public comments regarding a proposal for Medicare to cover treatment of HIV-related facial lipoatrophy with either of the two approved treatments. Now Medicare is proposing coverage of such treatment, but with the requirement that depression is also present.

According to the proposal, detailed in a December 23, 2009, memo, “Dermal injections for facial [lipoatrophy] syndrome are only reasonable and necessary using dermal fillers approved by FDA for this purpose, and then only in HIV-infected beneficiaries who manifest depression secondary to the physical stigmata of HIV treatment. All other indications are noncovered.”

People who wish to comment on this proposed decision, and share their story or the story of a loved one who has suffered from facial lipoatrophy, may do so by clicking here.

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Previous Comments:

Bill B, Boston, 2010-01-26 11:25:18
Facial wasting is devasting. Does it lead to depression? It is probably one one of the largest single factors that can excellerate a downward spiral in one's mental health even when other factors are going well. The cost is out of sight! It is not simply and elective cosmetic procedure. It is facial reconstruction used to mitigate the consequences of a systemic illness. Anything short of coverage is discrimation.

jim, honolulu, 2010-01-21 20:13:25
I think this a great idea. But how do you prove that you are depressed. Should I go to to medicare office in tears. I think that my word should be enought. I can say that I have spent about $4000. for treatment but can not pay anymore. I am always conscious when I meet someone and am always trying to keep any light in my eyes because I feel the wasting will show more with back lighting. Am I depressed? I do know I avoid the public if at all possible. I try to remain in the dark places.

don, , 2010-01-21 16:58:30
i do believe all healthplans (HP)should cover procedures for facial wasting. off point i have noticed some HPs have gone to percentage coverage of meds. which for example has put my copays from 30x5 to $100.00x5 (for my partner & myself)for antiretroviral meds. if this is a new trend to offer employers this option for pharmacy benefits coverage to their employees so they (employer & HP) can save money, we have an issue coming down the pike for sure. my option might be to stop taking my meds

Eddie Martinez, Malden, 2010-01-20 21:51:57
I'm a long term surviver and have been on many treatments. One thing that keeps me going is the thought of finding the cure some day. Like every HIV patient I too have suffered from depression anxiety and fear. I have facial waisting syndrome and I have to look at my face everyday which can be very depressing because I know that I could look better and feel better about my self. I welcome this new treatment and many HIV+ people will welcome it as well.

William Corr, Palm Springs, 2010-01-20 21:13:08
A ridiculous proposal. Following Medicare's logic, women with breast cancer should not be entitled to reconstructive breast surgery unless they are clinically depressed. Facial injections should be allowed to PREVENT depression. Facial wasting tells the world one has AIDS or HIV. I don't think I was "depressed" but I was very self conscious until I had Sculptra injections 3 years ago. They did wonders for my self esteem.

gary, victorville, ca, 2010-01-20 15:46:42
after a trip to Tijuana and years of enduring facial wasting from the drugs I took, this is a most welcome bit of news. There is hope. Medicare is willing to help erase the giant scarlet "A" on my face.

Terry, Ft. Lauderdale, 2010-01-20 13:05:05
Medicare already approves penile implants for impotence due to a medical condition for 65+ y.o. heterosexual recipients seeking to improve the quality of their lives (they're probably not seeking to procreate). It's well-documented that HIV (a medical condition) causes FLS. Derma fillers improve the quality of life for people with FLS, and it should be approved without having to prove that FLS caused depression that a HIV+ person may already have from the virus, the diagnosis and/or treatments