Women’s health: Stakeholders push to increase access

WASHINGTON – Supporters of women’s health legislation to increase access to custom breast prostheses and compression garments hope to gain needed momentum this fall to get their bills passed before the end of the year, they say. 

The Breast Cancer Patient Equity Act of 2021 would provide coverage for custom fabricated breast prostheses. The House bill, H.R. 3087, sponsored by Judy Chu, D-Calif, has 15 co-sponsors; the Senate companion bill, S. 2051, co-sponsored by Sens. Tammy Duckworth, D-Ill., Lisa Murkowski, R-Ala., Sherrod Brown, D-Ohio, and Amy Klobuchar, D-Minn., has yet to pick up additional co-sponsors. 

“It’s been slower on the uptake,” said Nikki Jensen, vice president of Essentially Women, a division of VGM. “One thing that’s different this time is we don’t really have the opportunity to go to Washington, D.C., and have face-to-face conversations and that’s where we’ve had the most success (in the past). We’re hopeful we can get included in a Medicare fix package at year end. If there were to be a women’s health package, we would look to that, as well.” 

While many private insurers cover custom breast prostheses, Medicare does not, saying they are not “medically necessary” and do not increase functionality.   

“When it comes to their interpretation, they only look at off-the-shelf codes and a fee schedule established in 1999,” Jensen said. “They look for the least costly alternative.” 

Stakeholders are also working with the office of Sen. Chuck Grassley, R-Iowa, to get the bill re-scored after an initial score from the Congressional Budget Office in December 2020 came in much higher than expected. 

“It was as if the CBO scored it as all women would choose custom breast forms, not taking into consideration OTS or surgical options,” Jensen said. “We believe that there would be a cost savings with passing this bill because, especially with Medicare-aged women, given the choice between the three options, those women who would have leaned toward surgery would choose custom breast forms if that were an option.” 

Also waiting for a CBO score: legislation that would require Medicare to pay for compression garments, bandages and supplies to reduce lymphedema-related swelling and prevent recurrence. The Lymphedema Treatment Act would save Medicare $1.3 billion to $1.5 billion during the first 10 years through avoided hospitalizations, says Heather Ferguson, founder and executive director of the Lymphedema Advocacy Group, which commissioned Avalere to estimate the savings of the act. 

“In August, the (House of Representatives) Energy & Commerce Committee requested our score, and we are eager to see what the CBO has to say now that we have been able to present them with strong evidence for cost savings,” she said. “We haven’t gotten any response yet.” 

Both the Senate bill, S. 1315, introduced by Sen. Maria Cantwell, D-Wash., and the House bill, H.R. 3630, sponsored by Jan Schakowsky, D-Ill., have been gaining co-sponsors, with 67 and 262, respectively since being introduced in the spring. At press time, supporters were making the case to have the language included in the budget reconciliation package, said Ferguson. 

“The bill perfectly aligns with two of the administration's main goals for this human infrastructure package: expanding Medicare coverage and lowering prescription costs,” she said. “If we are not included in this package, we’ll of course be looking for any other opportunities.”