Treatment News : Sign-On to Support an Increase in Medicare Reimbursement for Facial Fillers

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April 8, 2011

Sign-On to Support an Increase in Medicare Reimbursement for Facial Fillers

A prominent AIDS activist is asking people with HIV and the organizations that serve them to sign on to a letter asking the agency that sets reimbursement rates for Medicare to boost the rate it offers doctors to administer the facial fillers Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite).

Activists thought they’d won a major battle when the Center for Medicare and Medicaid Services (CMS) announced in March 2010 that the government health insurance program would begin covering the costs of Sculptra and Radiesse for people who have psychological trauma due to loss of fat in their faces, a condition known as lipoatrophy or facial wasting.

Sculptra and Radiesse are both temporary facial fillers that require touch-ups at least once per year for most people. The retail cost of a vial of Sculptra or Radiesse usually tops $500. As most people need a minimum of four to six treatments, and as doctors charge about $500 to $900 to inject the filler, a full course of treatment can easily exceed $4,000.

It’s the latter point, reimbursement for the physician’s fee, that has Nelson Vergel, a longtime AIDS activist from Houston, and other activists up in arms. Though doctors typically got $500 or more per treatment from their cash-paying patients to inject the facial fillers, Medicare is typically reimbursing only about $80. Obviously, the math doesn’t add up.

“The cost of acquiring and administering the product is higher than the payment amount set by Medicare,” he explains in the letter he’s asking people to sign on to. “As a result, physicians are not accepting Medicare payments for this service, and patient access to these effective therapies remains quite limited at the current reimbursement rates.”

To sign on to a letter demanding that Medicare increase its reimbursement rate for Sculptra and Radiesse treatment, click here before April 18.

Search: Sign-on letter, Medicare, reimbursement, facial filler, facial wasting, lipoatrophy, Sculptra, Radiesse, Nelson Vergel, CMS


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  comments 1 - 15 (of 22 total)     next > >>

randy schaefer, kingman, 2012-11-07 22:48:12
where do i sign the letter and get help as well im exhausted with medicare trying to figure it out

alexg536, Oakland, 2011-06-22 18:11:51
Very nice site!

Kevin, Independence, MO, 2011-05-22 16:06:01
I have the opposite problem, too much fat in the wrong places due to lipodystrophy. I signed the letter, in a show of support for all of us that have this problem. I have heard that Egrifta, a drug to help treat people like me, is now FDA approved and my doctor is trying to get it for me. As a long-term survivor of 24 yrs, I understand more about medicine than I ever wanted to.

Jonah, Minneapolis, 2011-05-05 11:25:43
When it is actually the drugs causing facial wasting, and not HIV itself, I think the focus should actually be more pressure upon the pharmaceutical companies to refine their drugs to eliminate such side effects. Especially with recent price hikes in some medications; they can raise the prices, but we should overlook the physically/emotional/social scarring their drugs do - simply because it fights HIV to a degree? Class action lawsuit I say, instead of pressure for additional facial fillers.

Jason Farrell, Amsterdam, Netherlands, 2011-05-03 15:55:34
This is a ridiculous request. With states ADAP budgets almost bankrupt and thousands waiting to gain access to life saving medications, asking for increase in federal support for this angers me. Any increase in federal finance support should go to those waiting to get medications they direly need. Yes there are extreme cases where folks do need facial reconstructive filling, I rather support keeping it as a Medicare billable item and keep additional funds for medication access

Philip J, Picayune, MS, 2011-04-26 16:19:48
I hope they can approve an increase in the amount medicare will pay for this. It was exciting when I heard they appoved this but I still cannot afford it.

Patrick Satterthwaite, Honolulu, 2011-04-16 14:02:37
Ridiculous that the procedure is approved but no doctor is willing to do it for the paltry sum that Medicare is willing to pay. Even doctors that the VA recruits are unwilling to work with the minimal $$$ that the VA pays (similar to Medicare I think).

Lee Miller, Golden, Colorado, 2011-04-15 17:07:01
My hope is that is an understanding that the treatment not only nessessary for phyical wellbeing but mental well being for those with lipodystrophy.

David Evans - AIDSmeds, New York, 2011-04-15 15:37:39
Michael, the link appears to be working for us. Is there a chance that you or something with the same computer already looked at the letter? Sometimes Survey Monkey will only let you look at a letter once. If that's the case, you can look in your cookies in your browser and remove the cookies or try following the link from another browser.

msoftie, Dallas, 2011-04-15 11:16:15
I have spent about 20 thousand dolllars and done more than 18 trips to get injections and I think MC should cover more permanent options. I hate the thought of spending another dollar to be tortured in the chair for it not to be more permanent. Years ago,I spoke to the FDA for the approval of Sculptra and 12 painful sessions later, I'm not much better than before. Silicon microdroplet is the ONLY thing that worked for me. It recommnend, DONT WASTE YOUR money, pain & suffering for Sculptra

DEAN K COX, Kingston, 2011-04-15 09:37:15
The rule as it stands now is worthless. Big Pharma is not selling it's product, MDs cannot charge a reasonable fee and patients cannot get care they need. A reasonable and customary fee schedule would be a win-win for all concerned.

Ronald Scheraga, Alexandria, 2011-04-15 00:07:48
When my facial wasting hit, I started feeling sick, not being sick. Feeling sick. One time, a litte girl in a market pointed to me, and sked her father what was wrong with the man. I had to g on pills for depression. This is not cosmetic surgery to look pretty. his is a medical procedure to help me not feel like scum.

Michael, Hanahan, SC, 2011-04-14 14:51:36
The link from the "click here" at the end of the article goes to a SurveyMonkey sign-in page that does NOT get me to the letter... Anyone have a working link to sign onto this ????

John Goldfarb, Los Angeles, 2011-04-14 07:18:48
This treatment is essential for the well-being of HIV-positive patients with lipodystrophy.

David Chaille, Long Beach, 2011-04-14 01:17:14
The current reimbursement rate is undermining the availability of the treatment. Doctors are losing money.

comments 1 - 15 (of 22 total)     next > >>


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