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CD4 Criteria for Sculptra/Radiesse?

Oct 10, 2010

After years and years of waiting, Kaiser Permanente in Oregon is finally covering facial correction for lipoatrophy for those on Medicare. But their criteria is that it can only be done for patients with a CD4 count above 300. Unfortunately, although undetectable and very healthy, my CD4 count has fallen by 250 points in the past year, now under 300. (That's a whole other question). I am distressed that I am unable to meet their seemingly arbitrary criteria, and I am probably no longer even eligible for the patient assistance program if I go outside of Kaiser Permanente because of my eligibility under Medicare. I've even considered forcing my CD4 count up with Interlukin-2 to meet their criteria, even though there is no other clinical benefit to doing that. Another option I'm thinking of is PMMA. But financial issues are also a concern. After waiting for years -- this has been distressing for me. Is there is medical data that supports their decision not to do these treatments for those who are under 300 CD4 counts, who are otherwise healthy?

Response from Dr. Pierone

Hello and thanks for posting.

Since you are eligible for coverage under Medicare, why should Kaiser's arbitrary decision matter? I am not aware of data showing less effect, or greater risk of lipoatrophy treatment in patients with under 300 CD4+ lymphocyte counts. Personally, I have treated many patients with counts under this threshold without problems.

Regardless, you should speak to Kaiser and see what they were thinking (if they were thinking). There is no way you should risk the side effects of IL2 to get a temporary boost in CD4+ lymphocyte counts.

Good luck!

Medicare and Facial Wasting in Florida
Reply to Dr. Pierones Question Re: My Post

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