Sculptra

[Guest guest]

Let's not kid ourselves, the big prize for Sculptra has always been for cosmetic purposes. They don't care about us a bit-- we were just the convenient, cost-effective, and willing guinea pigs. All that was obvious---as soon as they got limited FDA approval Dermik tripled the price, since they could then go "off label" to the market they were really interested in-- old ladies with money.Ill be suprised if this ever gets approved for reimbursement. And it's probably not going out on a limb too far, to predict the demise of the Patient Assistance Program--probably sooner rather than later. Yes, boys and girls, we have been played. Good luck to everyone who scored it "cheap" on the P.A.P. when you need periodic refreshers that you won't be able to afford.>> Did everyone catch the TODAY show report on Sculptra this morning? Focus was> on cosmetic use for ageing; there was a mention that it has been used in> PWAs as part of a safety discussion.> > > Don't think this will advance reimbursement efforts any . . . > > Bob

[Guest guest]

Look at it from a commercial point of view, it would not look enticingfor the average person to use a product designed for HIV/AIDS especially if they start using pictures of wasted people, and that is another sensitive issues.It might not be seen as appropriate to show wasted people in TV as it might be frown upon as insensitive.There is also the marketing point of view, that show you saw was target it toward beauty treatments not HIV and it might be the marketing department at Sculptra feels the product is well advertised in the HIV market and doctors know the productwhile in the beauty market Sculptra might be seen as a newcomer and not as widely known.What is important to remember is that Sculptra has a decent assistense programthat

gives free product away to people in need and that is more then most pharma have done.As for advancing the reimbursement issues, that will not come from TV morning shows,some people might feel sorry for HIV but they are not going to campaign for these kind of issues, to them is just some thing foreign to their own life experience,we might have more luck with some thing like the Opra show, I bet could get on the show in team with some reputable doctors and activistsand address the heath care cost issue related to HIVFrom: Bob Munk <bobmunk@...>Subject: Sculptra Date: Friday, August 21, 2009, 10:17

AM

Did everyone catch the TODAY show report on Sculptra this

morning? Focus was on cosmetic use for ageing; there was a mention that it has

been used in PWAs as part of a safety discussion. Don’t think this will advance reimbursement efforts

any . . . Bob

[Guest guest]

We'll see how long that lasts now. I've heard rumblings that the P.A.P. is on its last legs already. We'll see what sanovi-aventis does now, since they'll have a huge cosmetic market and a huge revenue stream now on this product.With a new ($$$ paying) customer base, they will certainly be able to afford to be quite generous with their Patient Assistance Program as well as be able to cut the price of the filler. Anyone want to place bets on whether they will?> ....What is important to remember is that Sculptra has a decent assistense programthat gives free product away to people in need and that is more then most pharma have done......>

[Guest guest]

I understand that Sculptra is now accepting Medicare, does that cover the cost

of the vials or does it cover the doctors injection fee.

Thanks for your help

[Guest guest]

Hi Jake,POZ magazine just did a story on this. Here it is: Losing Face Fillerby Tim Medicare coverage of Sculptra and Radiesse fizzles.Last March, HIV-positive people with facial lipoatrophy (loss of facial fat caused by HIV or the meds) rejoiced as Medicare announced it would reimburse doctors for injecting the fillers Sculptra and Radiesse. The news, it was hoped, would inspire more doctors to provide the treatment. But Medicare set treatment reimbursement at a paltry $100 per visit (several are usually required), and most HIV doctors charge about $400 to $500 per visit for the procedure; non-HIV specialists charge up to $900. “The coverage is obviously a disappointment, and I doubt doctors will be flocking to provide this service,†says

Gerald Pierone, MD, a Florida HIV doc who does the treatments. Doctors and patients also say regional Medicare contractors have not followed through on reimbursements and don’t seem to understand the new, required coding for them. One HIV-positive man in ton, South Carolina, says Medicare has yet to reimburse his doctor for “Round 1†of the treatment. “Almost five months after my first session,†he says, “the possibility of additional treatments, which might help me [have] a ‘normal’ appearance, is still up in the air.â€Medicare rep Ellen Griffith insists there was a public comment period before rates were set, but Vergel, an HIV-positive advocate on the issue in Houston, says, “They never showed us any proposed rates to comment on.†The rates aren’t up for revision until November 2011, but “an onslaught of letters to Medicare [7500 Security Blvd, Baltimore, MD 21244] from patients will

help put the ball in motion,†says Doug Mest, MD, an HIV doctor in DC who does the procedures. In the Meantime…If your HIV doc doesn’t do the procedures or can’t refer you to one who does—and who accepts Medicare—go to medicare.gov, click “Facilities and Doctors†at left, then “Find a Doctor,†then search with the “Dermatology†specialty.Once you find a Medicare-accepting doctor who’ll do the treatments, make sure he or she bills Medicare with this info:1. A date of service (LIDOS) on or after March 23, 20102. A line with the HCPCS code Q2026 (Radiesse) or the HCPCS code Q2027 (Sculptra)3. A line with the HCPCS code G0249 (dermal filler injection procedure)4. The ICD-9-CM diagnosis codes 042 (HIV) and 272.6 (lipodystrophy)If you hit a wall, contact Vergel via facialwasting.org. He’ll be gathering patient testimony to urge Medicare to revise coverage rates. From: Jake <jockrog@...> Sent: Fri, January 21, 2011 12:36:22 PMSubject: Sculptra

I understand that Sculptra is now accepting Medicare, does that cover the cost of the vials or does it cover the doctors injection fee.

Thanks for your help

[Guest guest]

I'm the " man in ton, SC " mentioned in the article... It's now over 8

months since I got 2cc's Sculptra & my doc STILL hasn't been reimbursed! They

re-submitted the billing (with all the proper codes and diagnoses and the actual

invoices for the product) so many times I've lost count. We're waiting on the

results of the latest re-re-re-re-submission. And I have no hope whatsoever

that this region's reimbursement rate is any better than ony other, anyway. I

strongly urge EVERYONE on this list to send the letter to CMS noted in 's

article.

Mike

[Guest guest]

..Hi Lily,

I don't want to give you false hope because it could be a very individual thing, but I was once very gaunt in the face. I do remember how depressed it made me and I was very self-concious about it and I isolated as a result. It was probably partly due to d4t use, azt use and just not having an appetite for food (so I didn't eat much). After being put on combo meds (improved appetite immensely) and before that taken off d4t and then later after combo meds taken off azt, most of my facial fat came back, but it took years to do so. I'm hoping that it continues to fill out some more over time. The meds I'm on now are Sustiva and Epzicom. Is there anyone else on the listserve that this has happened to? There's only one other person on the list who told me it happened to them and they had already had either sculptra or bioalchemed put in their face first. I don't want to name names.

"has anyone in houston or the sourounding areas found a Dr. or dermatalogist that will take medicare for sculprta??? WTF now we cant even get it at all? because of politic...They just made it to where we have lost everything:( Am I going to have to walk around an look gaunt like I have aids again..dont think I can afford retail. Im having panic attaches over this...Anyway thank to anyone who can give me adviselily:(