It's Time to Reengage with the Breast Cancer Patient Equity Act

Published in Women's Health on May 29, 2020

Due to the COVID-19 public health emergency, Washington, D.C. and progress on many legislative issues came to a halt. The country is beginning to open back up and non-emergent surgeries are taking place again. Because of COVID-19, now more than ever women will be looking for lower risk and non-surgical options after a mastectomy. It is incredibly important that breast cancer survivors have all the reconstruction options available to them after mastectomy surgery, whether that be surgical reconstruction, off-the-shelf prosthesis, custom breast prosthesis or to go flat. Now more than ever, it is critical that S. 562/H.R. 1370, The Breast Cancer Patient Equity Act is passed.

We’ve taken our foot off the gas for a few months with the legislation, but now is the time to reengage with your legislators and your clients about this important legislation. Many people don’t realize that custom breast prosthesis isn’t covered until you let them know about it.

Currently, Medicare does not view custom breast prosthesis as medically necessary and therefore, does not provide reimbursement. In fact, the breast is one of the only custom body parts that is not covered by Medicare. They provide reimbursement coverage for surgical reconstruction and all revision surgeries and off-the-shelf prosthetics.

Surgical reconstruction may not be appropriate in all circumstances. A person may not be a candidate, or she may not want to undergo additional surgeries. COVID-19 complicates matters even further, making surgery or a hospital stay less appealing and a higher risk for immunocompromised women.

Off-the-shelf prosthetics require a pocketed mastectomy bra and can shift. Symmetry between the remaining breast and the prosthetic isn’t always possible as the prosthetic is prefabricated. Skin tone options are limited to two colors, making it hard to match. Often, nylon hose is used to help provide a better skin tone match.

Custom breast prosthetics are a non-invasive, non-surgical and lower risk way to reconstruct the breast after a mastectomy. A custom prosthetic is contoured to the woman’s chest wall and fits like a puzzle piece, which allows for it to actually move with her and provide symmetry since it is custom made in all sizes. There are also more than 36 skin tone color options available, making it easier to match.

We believe breast cancer survivors should have all options available to them after a mastectomy. Legislation is needed for Medicare to include this as a covered benefit. As we all know, many insurance payers follow Medicare guidelines.

We need your help! Now is the time to contact your legislators to ask them to sign on to the Breast Cancer Patient Equity Act.

Senate Cosponsors House Cosponsors

Take Action: Send a letter to your elected officials asking them to support the Breast Cancer Patient Equity Act. (The email has already been written so it’s really easy!)
Call your elected officials to request that they sign on to the legislation. Let them know how breast cancer and access to custom breast prosthesis has affected your life. Use this phone call guide to help you.
Like and Follow the Let Her Decide campaign on Facebook and invite your friends too!
Tell all of your customers about this important bill and how they can help by taking action. (Hint: Have counter cards ready to give to all of your customers.)
Contact local breast cancer support groups and ask if you can come speak about the Breast Cancer Patient Equity Act and Let Her Decide Campaign.

Your legislators need to hear how important this bill is from their constituents- that’s you and your patients! If they don’t hear it from you, who will they hear it from?

Need help? Call Essentially Women at 800-988-4484 or email us at essentiallywomen@vgm.com.

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