U.S. Rep. Martha Roby (R-AL) wants to give breast cancer survivors the option to receive custom fabricated breast prosthetics after a mastectomy that are paid for by federal monies.
“It has recently come to our attention that custom fabricated prosthetics are not covered by the Center for Medicare and Medicaid Services (CMS) for women who are either not candidates for reconstructive breast surgery or who do not prefer to endure additional surgery following a mastectomy,” Rep. Roby wrote in an Oct. 29 letter to CMS Administrator Seema Verma.
“Unfortunately, CMS currently deems a custom fabricated breast prosthetic, which is significantly less expensive than reconstructive surgery and would be a custom fit to a woman’s unique body shape and needs, as not reasonable and necessary,” the congresswoman wrote.
Rep. Roby urged Verma to “review and reconsider the Local Coverage Determination” as it relates to such prosthetics, which are a combination of a pocket bra and silicone inserts.
Currently, CMS offers two choices for women following a mastectomy: breast reconstructive surgery or a prefabricated breast prosthetic, which “have been described as shapeless, heavier than the normal breast, and both hot and cumbersome to wear,” according to Roby’s letter.
“It is our understanding,” the representative wrote, “that the coverage determination for custom breast prosthetics … can be addressed within CMS through its current authority and does not require a legislative fix.”
Rep. Roby also requested an update on the situation be provided “in a swift and timely fashion.”
“It is only right that women who have battled breast cancer be given the options that work best for them and not be subjected to a one-size-fits-all approach,” she wrote.