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Lymphedema stakeholders eager to move forward

Lymphedema stakeholders eager to move forward Now the work of setting reimbursement rates, other details, begins

Heather FergusonWASHINGTON – After 12 years of making steady gains, women’s health stakeholders were elated when the Lymphedema Treatment Act was included in an omnibus bill passed by Congress in December. 

“We finally got to the front of the line,” said Heather Ferguson, founder and executive director of the Lymphedema Advocacy Group. “There was a vehicle available, and it all fell into place at the right time.” 

The legislation will require Medicare to pay for compression garments, bandages and supplies to reduce lymphedema-related swelling and prevent recurrence, starting Jan. 1, 2024. 

The coverage is a big deal for patients living on fixed incomes, says John Holland, head of sales for Chicago-based Absolute Medical, who has almost 20 years of experience measuring and fitting patients with lymphedema. 

“I know firsthand how much this will mean to the Medicare population in my area that have to sacrifice food and other medications just to be able to afford the correct compression garment,” he said. 

Stakeholders have already reached out to CMS to learn about next steps and timelines, and to ensure coverage is implemented in the way it was intended, says Ferguson. 

“This next year is extremely important,” she said. “There will be regulatory decisions to set reimbursement rates, how many garments a patient can get at one time and how frequently they can be replaced. We want to know what the opportunities are for all the stakeholders to be engaged and provide feedback throughout that process.” 

The language that passed included a streamlined description of what supplies would be covered to ensure that, down the road, stakeholders won’t find themselves back at the table, says Ferguson. 

“It defers to the secretary the authority to add other compression supplies, in addition to standard fit and custom fit,” she said. “Hopefully, that gives them the latitude to include anything currently on the market, but also the flexibility to add a new product that might not currently exist.” 

  • Read about efforts to increase access to compression garments, as well as breast prostheses, here.


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