EW readies for legislation to drop

WASHINGTON - With the end of the August recess in sight, women's health advocates anticipate the House of Representatives and the Senate to quickly introduce a pair of bills that would require Medicare to pay for custom breast forms.

“We have our draft legislation and we are actively seeking lead sponsors,” said Nikki Jensen, vice president of Essentially Women, a division of VGM. “We are hoping they drop within the next few weeks and, hopefully, get passed this year.”

Similar bills have been introduced in the past, most recently in 2011. Medicare already has a code and an allowable for custom breast forms, but local coverage determinations (LCDs) downcode them as "not medically necessary." That means custom forms get reimbursed at the non-custom allowable. Custom forms range in cost from $2,500 to $3,000 compared to $350 to $400 for off-the-shelf products.

Custom forms may be the only option for women who for, for various reasons, may not be a good candidate for reconstructive surgery or for whom off-the-shelf products may not work, says Jensen.

“They may not want more surgery,” she said. “For an OTS item, it may not be possible to find a good match.”

Jensen and other stakeholders have spent the summer laying the groundwork for the legislation, including a trip to Capitol Hill in July and the launch of a grassroots campaign, #MakeMeWholeAgain, with a Twitter hashtag, Facebook page and web page, www.makemewholeagain.com.

“We want to push (the legislation) out through EW's 575 members across the country to talk about with the patients they serve, as well as support groups and referral sources,” said Jensen. “When we first launched the social media campaign, we were surprised at how quickly it took off.”

Once the legislation drops, visitors to the web page will be able to take action to let their members of Congress know that it's important for women facing mastectomies to have options, says Jensen.

“We want the option to have custom forms available so each woman has the ability to make the choice about what's best for her situation,” she said.