The human body is designed in such a way as to function within limits. These limits are set using structural connectivity through joints, tendons, ligaments, muscle fibers and other self-limiting tissue. The reason behind this functionality is to allow for range of motion without pain, but sometimes, tissue damage or disease can have a negative effect on these connective elements, leading to deformities. Not only can these problems cause pain or limit range of motion, but they can also lead to self-esteem concerns, especially when they occur in sensitive areas like the genitals.

Although there are many ways in which connective tissue can be damaged or limited due to injury or disease, two common conditions are Dupuytren’s contracture and Peyronie’s disease. In Dupuytren’s contracture, the fingers are pulled in toward the middle of the palm due to fibrous tissue growth. This limits motion and can potentially lead to strain, injury and pain. People suffering from this condition may also be more prone to injury in the hand when everyday actions, such as opening a door, lead to additional strain on tendons that are inflexible.

In Peyronie’s disease, a plaque develops beneath the skin of the penis, and when erect, the penis suffers a noticeable curvature that can cause pain and discomfort during sexual activity. The cause of Peyronie’s disease may stem from trauma, likely due to injuries sustained during sexual activity, but genetic factors may also lead to the development of the disease. For both Dupuytren’s contracture and Peyronie’s disease, prescription medications like Xiaflex may help.

What is Xiaflex?

Xiaflex (collagenase clostridium histolyticum) is a medication developed by Endo Pharmaceuticals and is an FDA-approved treatment for structural deformities that are caused by injury or genetic factors that lead to inflexibility in connective tissue. The medication works by breaking down plaque development that can be the result of connective tissue tightening. It is administered as an injection, typically in a urologist’s office in the case of Peyronie’s disease. In most cases, people who receive Xiaflex injections will also need to add light physical therapy into a treatment routine in order to stretch affected areas as the medication breaks down a plaque or fibrous growth that is inhibiting normal range of motion.

Does Medicare Cover Xiaflex?

Medicare coverage for medications usually occurs under Part D; however, this is typically only applicable when the medication can be purchased from a retail pharmacy for self-administration. For medications that are administered in a clinical setting, Medicare Part B benefits may help cover the costs. Medicare Part B helps cover outpatient needs, including doctor’s office visits and treatments that take place in a medical office setting.

In order for Xiaflex to be covered under Medicare, there are some guidelines that must be followed. First, the patient must be diagnosed with Dupuytren’s contracture or Peyronie’s disease, and a physician must prescribe the medication as a medically necessary treatment. In cases of Peyronie’s disease, the curvature of the penis must be more than 30 degrees. For treatment of Dupuytren’s contracture, the patient needs to be experiencing a cord-like fibrous growth in order for Xiaflex to be effective in treating the condition.

Related articles:

Does Medicare Cover Naturopathic Doctors?(Opens in a new browser tab)

Does Medicare Cover DME?(Opens in a new browser tab)