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Medicare Will Now Cover Facial Fillers for HIV Positive People Experiencing Depression Due to Lipoatrophy

SUMMARY: The Centers for Medicare & Medicaid Services announced this week that Medicare will now pay for FDA-approved facial fillers such as poly-L-lactic acid (Sculptra) and calcium hydroxylapatite (Radiesse) for people with HIV who are experiencing symptoms of depression related to facial lipoatrophy/lipodystrophy, or fat loss, a side effect of certain older antiretroviral drugs.

Peripheral lipoatrophy is characterized by wasting of subcutaneous fat in the face and limbs. An adverse side effect associated with the earliest nucleoside reverse transcriptase inhibitors including zidovudine (AZT, Retrovir), stavudine (d4T, Zerit), and didanosine (ddI, Videx), lipoatrophy can result in sunken cheeks that reveal one's HIV status, causing feelings of stigma and psychological distress. Medicare (which provides health coverage for people age 65 and older) will now cover injectable facial fillers to correct the condition.

Below is the recent announcement from the Centers for Medicare & Medicaid Services describing the new policy.

Medicare Expands Coverage for Treating Facial Lipodystrophy Syndrome in People Living with HIV

March 23, 2010 -- The Centers for Medicare & Medicaid Services (CMS) today announced its decision to cover facial injections for Medicare beneficiaries who experience symptoms of depression due to the stigmatizing appearance of severely hollowed cheeks resulting from the drug treatment for Human Immunodeficiency Virus (HIV). Today's decision is effective immediately.

Facial lipodystrophy (LDS) is a localized loss of fat from the face, causing an excessively thin appearance in the cheeks. In some cases, facial LDS may be a side effect of certain kinds of medications (antiretroviral therapies) that individuals receive as part of an HIV infection treatment regimen.

The facial LDS can leave people living with HIV looking gaunt and seriously ill, which may stigmatize them as part of their HIV-infection status. Individuals who take these medications and experience facial LDS side effects may suffer psychological effects related to a negative self-image. These effects may lead people living with HIV to discontinue their antiretroviral therapies. The new decision allows for treatment of individuals who experience symptoms of depression due to the appearance changes from facial LDS.

The injections included in today's coverage decision are "fillers" that have been approved by the U.S. Food and Drug Administration (FDA) to be injected under the skin in the face to help fill out its appearance specifically for treatment of facial LDS. Data show that these injections can improve patient self-image, relieve symptoms of depression, and may lead to improved compliance with anti-HIV treatment.

"Today's decision marks an important milestone in Medicare's coverage for HIV-infection therapies," said Barry M. Straube, MD, CMS Chief Medical Officer and Director of the Agency's Office of Clinical Standards and Quality. "Helping people living with HIV improve their self-image and comply with anti-HIV treatment can lead to better quality of life and, ultimately, improve the quality of care that beneficiaries receive."

The final decision is posted on the CMS Web site.


CMS Office of Public Affairs. Medicare Expands Coverage for Treating Facial Lipodystrophy Syndrome in People Living with HIV. Media release. March 23, 2010.
















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