After nearly a decade of advocacy by Susan G. Komen, our community and many others, the Lymphedema Treatment Act was passed by the U.S. Congress in December of 2022. The bill created a new benefit category in Medicare for custom-fitted lymphedema compression garments and other approved items prescribed by a doctor or other health care provider starting in 2024.
Lymphedema, which commonly develops after some cancer treatments that remove or damage lymph nodes, affects an estimated 3 to 5 million people, with 1.5 to 3 million being Medicare beneficiaries. In breast cancer, lymphedema is most often related to axillary lymph node surgery (surgery to remove lymph nodes in the underarm area) and radiation therapy to the axillary lymph node area. The incidence of breast cancer–related lymphedema varies depending on the type of treatment received. It is estimated that one year after breast surgery fewer than 5% of women who had sentinel node biopsies developed lymphedema while 10%-20% of women who had axillary dissection developed lymphedema.[1]
Some communities are disproportionately impacted by the lack of coverage by Medicare of lymphedema treatment supplies with recent data showing Black women are three and a half times more likely than white women to develop breast cancer-related lymphedema.[2]
Medical compression garments are an essential treatment for lymphedema. Data demonstrates the use of prescribed medical compression garments significantly improves the health and quality of life for patients through reduced incidence of infections, hospitalizations and other costly yet preventable complications. However, once acquired, patients must pay the out-of-pocket expenses associated with purchasing prescribed compression garments creating a significant barrier to treatment.
Thanks to the new law, beginning on January 1st, Medicare now pays for standard and custom-fitted lymphedema compression treatment items for each affected body part. Visit this CMS webpage to learn the specifics about what is covered and how often. Komen’s Center for Public Policy is grateful to all the advocates from our community and beyond who persevered for nearly a decade to see this become law. This legislation is a huge step in reducing the financial burden of breast cancer on patients.
[1] https://www.komen.org/breast-cancer/survivorship/health-concerns/lymphedema/
[2] Barrio AV, et al. Impact of race and ethnicity on incidence and severity of breast cancer related lymphedema after axillary lymph node dissection: Results of a prospective screening study. Presented at: 2021 San Antonia Breast Cancer Symposium; December 7-10, 2021; Virtual. Abstract GS4-01.
