Medicare will now cover the use of facial fillers for beneficiaries whose facial lipoatrophy resulting from treatment for HIV infection has contributed significantly to depression, the Centers for Medicare and Medicaid Services announced yesterday.
The decision, which applies only to fillers specifically approved for use in facial lipoatrophy, became effective immediately, according to the agency's national coverage determination memo
Facial lipoatrophy, a side effect of highly active antiretroviral therapy (HAART), involves localized loss of fat from the face and thinning of the overlying skin, which causes an excessively thin and hollow appearance in the cheeks.
As the condition progresses, underlying facial muscles may appear more prominent, making the patient appear ill or prematurely aged. Fat lost from the face may 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 believe their relationships with others are adversely affected," the decision said.
About 13%-38% of HAART-treated patients suffer from facial lipoatrophy, leading some 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 only cover the procedure in patients whose gaunt appearance "is a significant contributor to their depression."
Studies have shown that use of facial fillers can improve patient self-image, relieve symptoms of depression, and may lead to improved compliance with antiretroviral treatment, CMS said in its decision.
Although HIV is rare in the over-65 Medicare population, HIV-infected individuals under age 65 years may qualify for Medicare based on 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 LDS, according to CMS, but the agency did not address those in its decision.