Custom breast forms legislation drops

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Thursday, October 4, 2018

WASHINGTON – A bipartisan bill that would require Medicare to cover custom breast prostheses was introduced in the House of Representatives yesterday.

The Breast Cancer Patient Equity Act, H.R. 6980, is co-sponsored by Rep. Rob Blum, R-Iowa, and Judy Chu, D-Calif.

“I am proud to introduce this bipartisan bill with my colleague, Democrat Rep. Chu, to provide women with coverage of more options following a mastectomy,” said Blum in a press release. “As breast cancer rates continue to rise and we work toward finding a cure, it is important to help the women who are fighting this battle and ensure they have options following this life-changing procedure.”

Medicare already has a code and an allowable for custom breast forms, but local coverage determinations (LCDs) down code them as "not medically necessary." That means custom forms get reimbursed the same as off-the-shelf products, even though they cost $2,500 to $3,000 vs. $350 to $400, respectively.

Essentially Women, a division of the VGM Group, spearheaded the #MakeMeWholeAgain campaign, a grassroots effort to advocate for the legislation.

“Women are unique and come in all shapes, sizes and skin tones,” said Nikki Jensen, vice president of Essentially Women in a press release. “Providing Medicare coverage for a segment of this population can give women an option that can meet their needs and make them whole again.”

Similar bills have been introduced in the past, most recently in 2011.