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Permanent Treatments for Facial Wasting- Are they being paid by insurance?
Dec 10, 2010

Nelson, are there any permanent fillers for facial wasting in the United States that are paid by insurance? I have used Sculptra 6 times and I am yet to restore my face. I am tired of it and want to try something that works and it does not need touch ups.


Response from Mr. Vergel


It amazes me that we still do not have a cost effective permanent solution to facial wasting.

The two options approved by the FDA (Sculptra and Radiesse) are non permanent and not cost effective for those with more advanced facial lipoatrophy. They both require yearly touch ups in most patients. Currently, Medicare pays for both but the reimbursement amounts are too low to entice doctors to use it for HIV patients. Both products have patient assistance programs that are decreasing in scope with time.

The other two products that can be used in the US for facial lipoatrophy but that are not approved for that use are Silicone 1000 micro droplets and Artefill, and both are permanent. Neither gets reimbursed and there are no patient assistance programs for them. It would be interesting to see an economic analysis of the total cost for each for a facial wasting grade 2-4 in a 5 year period. I would not be surprised that permanent solutions will be cheaper in the long run for some patients.

We have a lot of activist work to do to try to get something permanent approved for lipoatrophy that is not outrageously expensive and that has a good patient assistance program for those with no insurance (ADAP patients). Most people with facial lipoatrophy still have no access to treatments for that condition. Let's see what happens in the long run with Medicare and insurance rates for the two FDA approved options we have now. Unless something changes with a petition from the community, Medicare approval may actually hurt us more now since both companies are already reducing their patient assistance programs considerably after they assumed that Medicare would pick up a lot of the patients in their programs. If Medicare does not reimburse doctors properly, we will actually lose ground in this field. Tim Murphy from POZ is writing an article on this problem after he interviewed a few doctors who are having problems with Medicare right now.

I am encouraging companies from other countries that have cheaper PMMA to start studies on facial and buttock lipoatrophy in the US soon to get ready for the time when the patent of the expensive Artefill expires next year.


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