I had posted this in Care forum yesterday. I'm posting it here again today so more people can see it. Please post here after you email your letter to CMS. Moderators, if possible please move it back to the Care forum after Monday, August 31 the deadline to respond to CMS. Thanks.
I have been waiting for the longest time for Peristeen to be available through Medicare. First, there was the inordinate delay in FDA approval of Peristeen. Then Medicare had a code for it but no payment code (or whatever). So, sadly it has just been an empty wait so far.
I just got an email from Kade Agan at Coloplast which I'm copying below. There is a chance for all of us needing Peristeen to tell the concerned decision-maker at Medicare about the urgent need to make Peristeen available to Medicare enrollees by providing a benefit category AND a payment category for it.
So, please send your email letters to Dr. Stacey Brennan at the email address shown below and blind copy them to Valerie Bauler and Kade Agan at their email addresses. This is the only chance of our direct input to the right person at Medicare that I know of. So please, definitely send it before the deadline of Monday, August 31.
Even if you have other insurance paying for your Peristeen, please send your letter in detailing your experience to make it easy for those of us who have only Medicare. Also, in the long run, often private insurance companies tend to follow the CMS lead when deciding their own benefits. In other words, if Medicare approves payment for it, your private insurance will likely not remove the benefit.
Thanks all. Here is the email from Kade Agan:
From: Valerie Bauler
Sent: Wednesday, August 26, 2015 9:09 AM
Cc: Valerie Bauler
Subject: URGENT request- Deadline is August 31
All
We are at CMS today to discuss why Peristeen should be allowed to have a benefit category. We know this has created a hardship on many of our customers- those who cannot even begin the process due to Medicare status and those who have been denied insurance coverage because their insurance company recognizes the A4459 code but will not pay because there is no payment category assigned to it.
We would like to have as many patients as possible sending in their stories how Peristeen has impacted their life?s/situation but as well the difference before and after using Peristeen. The deadline is the 31th of August. Please forward this message to any one that you believe would like to have their voices heard. Thank you for taking time to write this e-mail. Their voice WILL be heard!
Key notes:
1. Please do not start off by stating Coloplast ask me to write?. use your own words to describe your situation and your issues.
2. Please blind copy Valerie Bauler
usvaba@coloplast.com and Kade Agan
uskaga@coloplast.com on your correspondence.
3. Please send your public comment to Dr. Stacey Brennan, via email only at
DMAC_Draft_LCD_Comments@anthem.com, in the following format:
Your name
Address
Contact info
Date
Stacey V. Brennan, M.D., FAAFP
Medical Director, DME MAC, Jurisdiction B
National Government Services
8115 Knue Rd.
Indianapolis, IN 46250-1936
RE: Bowel Management Device LCD Draft Policy Public Comment
? Brief Introduction & diagnosis/condition/length of impairment
? What have you or your child previously tried and failed before Peristeen (i.e. digital stimulation, simple enema, diet, laxatives, etc.)? Please provide detail as to how these all failed, why was Peristeen prescribed?
? If you or your child have experienced bowel accidents, how has that affected you or your child and/or your family, work, school?
? How does Peristeen affect your and/or your child's day-to-day living, family and quality of life (i.e. went back to school, back to work, able to be social, less time on bowel program, less accidents, etc).
? How would you or your child be hurt if Peristeen was not available? How would it impact your quality of life?
Your words should be written from your heart - only you can best express what you/your family go through on a daily basis. Anything you feel should be added to best express your views should be added.
Peristeen Urgent Action Needed: Bowel Management Device LCD Draft Policy Pub. Comment
