Bill Addresses Medicare Inequity for Mastectomy Patients

WASHINGTON — With the aim of eliminating an inequity in
Medicare coverage and providing another option to women who have
undergone mastectomies for breast cancer, Sen. Blanche Lincoln,
D-Ark., has introduced legislation calling for government coverage
of custom-fabricated breast prostheses.

S. 3255, the Custom Fabricated Breast Prosthetics Act of 2010,
would expressly provide coverage under Medicare for custom-
fabricated breast prostheses. The latter allows a lower-cost
alternative to reconstructive surgery; however, Medicare currently
covers only non-custom fabricated silicone or foam forms.

“As the most common cancer among women, breast cancer touches
the lives of millions,” Lincoln said. “The disease can be
devastating both physically and psychologically, and for those who
undergo a mastectomy, the impact is even greater … It is so
important for breast cancer survivors to have access to affordable
and viable options to ensure their best recovery possible.”

Lincoln noted that breasts remain the only body part whose
custom-fabricated prosthetic replacement is not reimbursed by
Medicare. That inequity deprives patients of a “valid, non-surgical
alternative following a mastectomy” and pushes more women to the
additionally risky, more expensive reconstructive surgery, experts
say.

That gap in Medicare coverage is in spite of what many have
called the “clear intent” of the Women’s Health and Cancer Rights
Act of 1998, which mandated that private insurers and group health
plans provide coverage for all stages of breast surgery and
reconstruction for women undergoing medically necessary
mastectomies.

“Under this new legislation, women and men will have a
non-surgical option for breast restoration,” said Susan Cassidy,
CEO of ContourMed, a Little Rock, Ark.-based manufacturer of
custom-fabricated breast prostheses. She added that if the bill
passes, it would provide “a medically necessary treatment option
for thousands of women in Arkansas and millions of women across the
nation.”

Rhonda Turner, president of the American Association of Breast
Care Professionals, applauded Lincoln’s bill, which is cosponsored
by Sen. Olympia Snowe, R-Maine.

“The Custom Fabricated Breast Prosthetic Act of 2010 addresses a
baffling and illogical inequity in the provision of breast care and
post-mastectomy coverage,” she said. “Simply put, a mastectomy is
an amputation. And the replacement of body parts — both
external and internal — requires custom treatment. However,
when replacing an amputated breast, Medicare has been denying women
this medically necessary treatment — custom breast
forms.”

Twenty-six- year cancer survivor Becky Caruthers of Arkansas
also supports the bill. A bilateral breast cancer patient, she said
a custom breast “is a must” for her because two surgeries resulted
in a difference of anatomy. She tried an off-the shelf model, which
proved to be too heavy, too hot and did not contour with her chest
wall, she said.

After four years, she was introduced to a custom breast form
from ContourMed. “That changed my life,” she said. “It made me feel
whole again.” The new form, she said, “took away the emotional
struggle I was having and replaced it with the ability for me to
swim and play with my child and have a life once again.”

Caruthers is such a champion of the custom fabricated prostheses
that not long after wearing the new breast form, she went to work
for ContourMed.

For the text of S. 3255, see thomas.loc.gov.