Government Relations Advocate for the Breast Cancer Patient Equity Act

Published in Women's Health on June 20, 2024

The week of June 3rd, Nikki Jensen, VP of Essentially Women and Ike Isaacson, SVP of VGM Government & Regulatory Relations traveled to Washington D.C. to advocate for H.R. 4779/S. 3069, the Breast Cancer Patient Equity Act. This bill would allow Medicare to recognize custom breast prosthesis as an eligible breast replacement following mastectomy surgery. Currently, Medicare beneficiaries are allowed the option of an off-the-shelf prosthetic or surgical reconstruction. Since December 2020, this bill has had an inflated Congressional Budget Office (CBO) score; misrepresenting the cost of this bill. Nikki and Ike met with the offices of Senate lead sponsors, Sen. Tammy Duckworth (D-IL) and Sen. Lisa Murkowski (R-AK) as well as House leads, Rep. Mariannette Miller-Meeks (R-IA) and Rep. Judy Chu (D-CA) to request letters be sent to the CBO to re-score the bill.

This bill is significant because some women are not candidates based on medical recommendations or for personal reasons, do not choose to undergo additional surgical procedures after their mastectomy surgery. Limitations to off-the-shelf prosthetics include proper fit against the chest wall after surgery and/or radiation, finding symmetry to their remaining breast or matching skin tone.

One in eight women will be diagnosed with breast cancer in their lifetime. Women don’t know what option they may need until faced with the decision. The objective of the Breast Cancer Patient Equity Act is to ensure women have the appropriate choice to make the decision that’s best for them at that time. Approximately 70% of state Medicaid programs, Tricare, and many private insurance payers allow coverage for custom breast prosthesis.

We encourage you to contact your legislators to advocate for this bill.

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