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Author Topic: Sculptra treatments, is it covered by Medicare now or not?  (Read 3045 times)

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Offline jm1953

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  • Posts: 255
Hey Members,

I have been getting Sculptra treatments for facial atrophy since 2004.  I have been getting the medicine through the patient assistance program through Dermik, but I heard that may be going away? 

My treatments run around $350.00 out of pocket.  Lately I've learned through another Poz forum, that Medicare will now pick up the meds and the treatment costs if it is proven that the patient suffers from major Clinical Depression, and not having the treatment is making the depression worse.  Of course documentation from lot's of physicians I'm sure are required.

I called my dermatologist today, because I am due for another touch up, and they said they had never heard of this and still charge as usual.

Can someone please enlighten me and the rest of those that use Sculptra?

Thanks as always,

JM
Positive 25 years. 7/21/2012 Current CD 4: 780 Viral load: less than 50. 38 to 40%
Current drug regimen, Isentress, , Emtriva, Sustiva Wellbutrin, Klonipin, Allegra, Ambien, Testosterone, Nandrolone, Vicodin, Benedryl, Aspirin, lots of vitamin supplements.

Offline Inchlingblue

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Re: Sculptra treatments, is it covered by Medicare now or not?
« Reply #1 on: May 23, 2010, 12:08:11 PM »
It seems they are covering it only if depression is also involved. Since this coverage is new it's probably best to see if anyone else has already done it in order to get a sense of how you must prove the depression aspect.

I suppose if you are seeing a therapist they can provide a letter or something?

LINK:

http://www.cms.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=234&

Here is more info/advice:

http://www.thebody.com/Forums/AIDS/FacialWasting/Archive/paying/Q208226.html
« Last Edit: May 23, 2010, 12:11:51 PM by Inchlingblue »

Offline Miss Philicia

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Re: Sculptra treatments, is it covered by Medicare now or not?
« Reply #2 on: May 23, 2010, 01:21:21 PM »
It seems they are covering it only if depression is also involved. Since this coverage is new it's probably best to see if anyone else has already done it in order to get a sense of how you must prove the depression aspect.

I suppose if you are seeing a therapist they can provide a letter or something?

LINK:

http://www.cms.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=234&

Here is more info/advice:

http://www.thebody.com/Forums/AIDS/FacialWasting/Archive/paying/Q208226.html

In the other thread that's been going on with this subject pozniceguy provided a link to the actual relevant passage in the detailed Medicare release that likely indicates that the physician doing to injection will be able to make the depression assessment.

As far as the patient assistance program "going away" I'd say no, not thus far as I was just approved for this two weeks ago.
"Iíve slept with enough men to know that Iím not gay"

Offline Inchlingblue

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Re: Sculptra treatments, is it covered by Medicare now or not?
« Reply #3 on: May 23, 2010, 01:38:48 PM »
In the other thread that's been going on with this subject pozniceguy provided a link to the actual relevant passage in the detailed Medicare release that likely indicates that the physician doing to injection will be able to make the depression assessment.
 

Yes, thanks for pointing that out. Here are the threads:

http://forums.poz.com/index.php?topic=31669.0

http://forums.poz.com/index.php?topic=31856.0
« Last Edit: May 23, 2010, 01:46:27 PM by Inchlingblue »

 


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