Obtaining Access to Sculptra® (Poly-L- Lactic Acid)

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Poly-L-lactic acid (Sculptra®) is a facial dershutterstock_324991481mal filler. It is available through the Pharmaceutical Benefit Scheme (PBS) and Medicare Benefits Schedule (MBS) for the treatment of facial lipoatrophy caused by antiretroviral (ARV) therapy for HIV infection.

Research shows that facial fat loss occurs very little (if at all) with modern and newer HIV antiretroviral treatments. Nonetheless, for those who have lived longer term with HIV this condition it is thought to be due to exposure side effects to older HIV ARV treatments, and may not be reversible – even upon switching to newer treatments.  For many longer termers the alternative solution has been to seek facial dermal fillers to rectify these effects.

Other facial fillers are available (such as hyaluronic acid, polyacrylamide, botox, etc), but Sculptra (poly-L-lactic acid) has been the most studied in HIV, and is the only product available for subsidy through the PBS for HIV-associated facial lipoatrophy. The injection procedures are also rebated through the MBS, although accredited practitioners can set their own fees above the scheduled MBS fee.

What is the cost of Sculptra® product?

Since 01 September, 2009, Sculptra powder for injection continues to be listed on the Pharmaceutical Benefits Scheme (PBS) for HIV-positive people, making this treatment affordable at the PBS co-payment rate.

The PBS listing for Sculptra® remains as:

  • Item 9475Q: Two (2) vials of Sculptra x four (4) repeats (total 10 vials) for initial and subsequent treatment; and
  • Item 9476R: Two (2) vials (only) for biannual top-up (maintenance) as required.

Together the total allowance is up to twelve (12) vials over a two year period. The PBS co-payment subsidy is in-line with all other medication you purchase at your pharmacy – currently (as at 01 January 2016) $38.30 per item for General patients (non-concession holders) or $6.20 per item for concession card holders $6.20 per item).

The PBS and Safety Net Thresholds indexed (increased) every year on 01 January.

What is the Medical Benefits Schedule (MBS) Fee for Sculptra® Injection Procedure by an Accredited Practitioner?

The manufacturers of Sculptra (Galderma) train and accredit practitioners to ensure competence in its injection to patients.  Accredited practitioners may set their own fees for the injections of Sculptra to their patients. Since 01 July 2011, funding has been approved on the Medical Benefits Schedule (MBS) for the procedure to inject Sculptra® (Poly-L-Lactic Acid) – facial dermal filler – for the treatment of facial lipoatrophy in HIV-positive patients.  Two Medicare Benefits Schedule (MBS) items are in place for eligible patients:

  • INITIAL SESSION (ITEM 14201): Limited to one or more Sculptra injections for the initial treatment session. This scheduled fee is set at $236.85 for which PLHIV may claim up to 85% of the benefit ($201.35) – The gap (out of pocket) fee counts towards your Original Medicare Safety Net (OMSN). The Extended Medicare Safety Net (EMSN) Cap is $35.55.
  • SUBSEQUENT SESSIONS (ITEM 14202): Continuation of Sculptra treatment (up to a maximum of four adjust­ment treatments, followed by one maintenance injection session every two years). This scheduled fee is set at $119.90 for which PLHIV may claim up to 85% of the benefit ($101.95). The gap (out of pocket) fee counts towards your Original Medicare Safety Net (OMSN). The Extended Medicare Safety Net (EMSN) Cap is $18.00.

Medicare Safety Net thresholds are indexed (increased) every year on 01 January.

Note: Costs may be reduced if an individual has reached their Medicare Safety Net Threshold and/or PBS Safety Net Threshold for the current year. Costs may also vary depending upon the number of procedural (consultation) visits you require, and the procedural fee/s set by a practitioner – Some practitioners may charge less than others. Some may bulk-bill, others may not. Some practitioners will prefer to give the treatment over several sessions. Others might be able to do so with fewer appointments thereby saving you time and money. For example, if you require only three (3) procedural visits, then your out-of-pocket fee costs will be lower than someone requiring more procedural visits and PBS purchase of the Sculptra product.

How do I find a clinic/practitioner close to me that can provide Sculptra® treatment?

There are many cosmetic clinics listed on the internet and yellow pages (you don’t need to see a cosmetic surgeon or dermatology specialist). Contact your chosen clinic asking them if they supply and are trained in the injection of Sculptra.  Some will advertise that they use this product in their clinic, whilst others may not.  Sculptra can be provided to anyone (for cosmetic purposes), although only HIV-positive people can obtain it through the PBS subsidy.  It will be important to ascertain if you wish to disclosure your HIV status to the clinic/practitioner in order to gain the PBS subsidy and MBS rebate with the above item numbers which are specific for HIV care.  It is unlawful for a clinic/practitioner to refuse access or not provide injections based upon HIV-status.

You may seek a referral from your HIV Doctor to a practitioner qualified to administer Sculptra. Check with your HIV Doctor, as some may also be qualified to prescribe and administer Sculptra.

The accredited practitioner will assess your condition and write an “Authority Prescription” for Sculptra. An Authority Prescription for Sculptra can only be written by a practitioner who has undergone training and accreditation to administer Sculptra.

Most clinic/practitioners will have stock of Sculptra available within the clinic. In that case you would pay them the PBS co-payment amount and issue your prescription to their suggested pharmacy (chemist), where replacement stock would come back to the clinic in that case.  Alternatively, you can fill your prescription at a pharmacy that stocks Sculptra, although not all pharmacies stock it, but most should be able to get it in within 24 hours. Check with your practitioner who has written your prescription (at your initial appointment) where to fill it if they do not have it in stock in the clinic. Clinics that have stock on hand will be more likely to provide your initial appointment (for prescription) and first injection procedure at the one visit. If not, it will be important not to fill your prescription from a pharmacy until close to your first injection visit.

Sculptra Program – Gladstone Road Medical Centre

Sculptra treatments are also available at Gladstone Road Medical Centre (GRMC) in Brisbane.

The Sculptra® clinic occurs on Mondays ONLY. The sessions are 6-8 weeks apart. PLHIV from across Queensland are invited to enquire directly to the clinic about access, even if you live outside of Brisbane but are able to attend the clinic in Brisbane.  You do NOT need to be an existing patient of GRMC, however everyone is required to be referred by their existing S100 (HIV) doctor.

Further enquiries can be directed to the GRMC Practice Nurse, Phone: 3844 9599.  Appointments are necessary.  Missed appointments will attract a no-show fee.  Out-of-pocket expenses may occur based upon the MBS fee rebate benefit and the PBS subsidised cost of Sculptra (see above).  Please enquire about these costs before making your appointment.

More Info?

PBS Listings:  http://www.pbs.gov.au/medicine/item/9475Q-9476R

 

PBS co-payments & PBS Safety Net Thresholds:

http://www.pbs.gov.au/info/healthpro/explanatory-notes/front/fee

 

MBS listings:

http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=T1.17&qt=noteID&criteria=poly-lactic%20acid

 

Medicare Safety Nets – OMSN and EMSN: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-ExtendedMedicareSafetyNet_Aug2014

 

March 2009 PBAC recommendation for PBS listing (Sept 2009):

http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/psd/2009-03/pbac-psd-poly-l-lactic-march09