Medicare will now cover the use of facial fillers for those beneficiaries whose facial lipoatrophy resulted from treatment for HIV infection and has contributed significantly to their depression, the Centers for Medicare and Medicaid Services announced.
The decision, which applies only to fillers that are specifically approved for use in facial lipoatrophy, became effective immediately, according to the agency's national coverage determination memo.
Facial lipoatrophy, is a side effect of highly active antiretroviral therapy (HAART).
It involves the localized loss of fat from the face and the thinning of overlying skin, which causes an excessively thin and hollow appearance in the patient's cheeks.
As the condition progresses, the underlying facial muscles may appear more prominent, which makes the patient appear ill or prematurely aged.
Fat that is lost from the face may then redistribute to other parts of the body, such as the abdomen, neck, and breasts.
“Patients have reported feeling stigmatized by these changes, particularly if their HIV status has not been disclosed previously,” and they may believe that their relationships with others are adversely affected,” the decision said.
About 13%-38% of HAART-treated patients suffer from facial lipoatrophy, which leads some of them to discontinue their medications, according to the decision.
Two fillers—Radiesse (calcium hydroxylapatite) and Sculptra (poly-L-lactic acid)—are approved by the Food and Drug Administration to correct facial fat loss in people with HIV.
According to the CMS decision, the agency will cover the costs of the procedure only in patients whose gaunt appearance “is a significant contributor to their depression.”
Studies have shown that the use of facial fillers can improve patients' self-image and relieve their symptoms of depression.
This improvement may lead to better compliance with their antiretroviral treatment, CMS said in its decision.
Although HIV is rare in the Medicare population that is older than age 65, some HIV-infected individuals who are younger than 65 years may qualify for Medicare, based on their disability.
Implants or injectable soft-tissue materials—such as bovine or human collagen, silicone, or autologous fat—also have been used to treat HIV-related facial lipoatrophy, according to CMS.
However, the agency did not address those substances in its decision.