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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

November 2016

Coverage of Treatment for HIV-Associated Lipodystrophy


The Massachusetts House and Senate recently passed a bill mandating that health insurance providers in the state cover treatment for HIV-related lipodystrophy syndrome, a debilitating potential side effect of antiretroviral drugs characterized by improper storage and distribution of fat throughout the body.

In keeping with this mandate, for dates of service beginning November 8, 2016, Harvard Pilgrim covers treatments to correct or repair disturbances of body composition caused by HIV-associated lipodystrophy syndrome for Massachusetts members.

Harvard Pilgrim has updated prior authorization and clinical medical policies for several cosmetic procedures to reflect this expanded coverage. To ensure appropriate coverage, providers must submit medical documentation verifying that the treatment in question is medically necessary for correcting, repairing, or minimizing the effects of lipodystrophy syndrome associated with HIV.  

Please refer to the following updated policies for further details:

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator