Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Are You Covered?
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a newly defined, locally aggressive T-cell lymphoma that can develop following breast implantation. In 2019, the National Comprehensive Cancer Network (NCCN) guideline recommended definitive treatment to be total capsulectomy with removal of the implant and to consider prophylactic contralateral removal. However, as a lymphoma, it is pathologically distinct from breast cancer, and thus requires its own policy from insurance companies. The authors evaluated the insurance coverage for the management of BIA-ALCL and compared it to the recommendation by the NCCN guidelines.
Methods/Technique:
The authors conducted a cross-sectional analysis of US insurance policies for coverage of breast implant removal in the setting of BIA-ALCL. Insurance companies were selected based on their market share and state enrolment. Web-based searches and telephone interviews were conducted to identify the policy. Medical necessity criteria were abstracted from the publicly available policies.
Results/Complications:
Of the 101 companies assessed, only 29 had a policy for the surgical management of BIA-ALCL. 100% of these policies provided coverage of the implant removal of the breast diagnosed with BIA-ALCL. Without a diagnosis, 14 (48%) policies allowed for the prophylactic removal of a texture implant, with 7 (24%) specifying the Allergan BIOCELL and tissue expanders. Furthermore, 7% of policies (n=2) covered removal of a breast implant for BIA-ALCL-associated symptoms alone. The most common coverage requirement was documentation of the original implant indication (n=7, 24%) whereas one in ten policies (10%) required a specific pathology or cytology diagnosis of the BIA-ALCL. For the contralateral breast, 18 policies covered their prophylactic removal. However, insurers were less likely to cover prophylactic contralateral breast implant removal if the original reason for the implant was cosmetic rather than medically necessary (41% vs 62%, p=0.0099). After removal of either implant, 22 policies covered an implant reinsertion, but again, fewer would do so if the implant was cosmetic rather than medically necessary (55% vs 76%, p=0.0040).
Conclusion:
Though a relatively novel diagnosis, the comprehensive guidelines by NCCN provides little excuse for the marked scarcity of insurance coverage for the treatment of BIA-ALCL. Furthermore, there is notable intercompany variation based on whether the original reason for the breast implant was cosmetic or medically necessary. This variability may significantly reduce access to definitive treatment in patients with a cancer diagnosis.