Nevro Corporation has announced that US health plan Aetna has updated its spinal cord stimulation (SCS) coverage policy to explicitly cover painful diabetic neuropathy (PDN), effective from 29 August 2022.
Nevro also recently announced that Novitas and First Coast, the Medicare administrative contractors (MACs) that represent Arkansas, Colorado, Delaware, Florida, Louisiana, Maryland, Mississippi, New Jersey, New Mexico, Oklahoma, Pennsylvania and Texas, published their draft local coverage determinations (LCDs), titled “Nerve stimulators for chronic intractable pain”, which propose updated coverage criteria to include PDN refractory to conventional medical management for SCS devices, with an explicit US Food and Drug Administration (FDA) approval to treat PDN.
If finalised, these LCDs will mean that Medicare patients in all 50 US states will have coverage for PDN and will add approximately 17 million covered Medicare lives, while also increasing coverage in the USA to roughly 66% of PDN patients. The review of these proposed LCDs is ongoing and potential finalisation dates have not yet been determined, according to a Nevro press release.
“These are very positive coverage advancements for the significant number of commercial and Medicare patients covered by these carriers, which will provide greater access to Nevro’s proprietary 10kHz therapy for PDN patients,” said D Keith Grossman, chairman, CEO and president of Nevro. “I am particularly pleased with the coverage decision by Aetna, [which] reconsidered its decision from earlier in the year and changed its SCS coverage policy to explicitly cover painful diabetic neuropathy.
“Our reimbursement team is continuing to work closely with payers to provide the published clinical literature for 10kHz therapy and to respond to any questions raised during their policy reviews. We believe our strong and growing body of published, peer-reviewed clinical and real-world data will be the basis for further coverage decisions by other major health plans in 2022 and beyond.”