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Lawmakers re-introduce legislation aimed at improving access to custom breast prosthetics

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WATERLOO, Iowa (KWWL) - A group of federal lawmakers has filed legislation affecting certain breast cancer patients and survivors. The legislation would give women who have had a mastectomy access to custom breast prosthetics through Medicare. Right now, only generic, over-the-counter prosthetics are covered in the program.

The bill, also known as the Breast Cancer Patient Equity Act of 2021 was introduced by Senator Lisa Murkowski, R-Alaska and Senator Tammy Duckworth, D-Illinois on June 15.

“We can do so much more to help survivors of breast cancer return to health and achieve the best quality of life,” Sen. Duckworth said in a statement. “This bipartisan legislation is an important step in continuing to expand healthcare coverage for women and achieving health equity for older women and women of color."

According to Essentially Women, a division of The VGM Group based in Waterloo, more than 100,000 women undergo mastectomies each year.

“After a woman overcomes what is, perhaps, the most challenging battle of her life," Senator Murkowski said. "This bill will expand coverage to help with physical and emotional healing.”

This is the fourth time the legislation has been introduced. It was previously brought up in 2012, 2018, and 2019.

"Breast cancer is not a partisan, disease, state or circumstance that anybody is part of," Essentially Women Vice President Nicole Jensen said.

Jensen and Essentially Women have been lobbying lawmakers to pass the legislation for the past several years. The group originally approached Medicare regulators to see if they could make the change but were told they needed an act of Congress.

In 2019, the bill made significant progress but was stymied by the pandemic.

"We heard from different sources that the medical directors for the jurisdictions that oversee the subcontractors were being told they should get ready to allow coverage and find a way to allow coverage for custom breast prosthesis," Jensen said. "Then the pandemic hit, and really everything came to a screeching halt at that time."

Data from the Center for Medicare and Medicaid Services obtained by Senator Chuck Grassley's office shows between 22016 and 2018, the number of mastectomy procedures increased, but the number of over-the-counter breast prosthetics used decreased.

Currently, women who want custom breast prosthetics have to pay for them out of their own pocket. According to CMS, they typically cost between $3 and $4,000. The off-the-shelf products can be poorly fitting.

"For women who don't have a flat chest wall, if they have areas that are concave or rippled or if she had area maybe underneath her arm that you know tissue or lymph nodes that had to be removed, she may have large gaping areas, and the prosthetic may not fit well against her chest wall," Jensen said. "We all come in different shapes and sizes. The off the shelf prosthetic is a prefabricated prosthetic, and it just may not be as symmetrical as a natural breast would be or a custom breast."

Custom prostheses are generally silicone implants that are created from a unique mold designed to fit the chest like a puzzle piece. Custom chest molds can also be made to match an individual's skin tone, something generic breast implants do not do.

"Women need to have different color options because we all come in different shades," Jensen said. "Whether we are white, brown, black, Caucasian, or Asian, we are all different colors. This is an opportunity for women to have a replacement of their body part to match their skin tone."

For breast cancer patients and survivors, Jensen said covering custom prosthetics implants under Medicare will allow them to feel like they are back in their own bodies.

The Senate version of the bill has been assigned to the Senate Finance Committee. A similar version has been introduced in the House, but it has not yet been moved to a committee.

Jensen encouraged people interested in getting involved to reach out to their representatives in Congress.

Essentially Women has resources on how to do so here.

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Daniel Perreault

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