Nevro (NYSE:NVRO) today announced positive updates to multiple spinal cord stimulation (SCS) coverage policies.
Aetna’s new SCS policy explicitly covers PDN (painful diabetic neuropathy), effective Aug. 29, 2022. Aetna’s health plan covers approximately 22 million commercial lives.
Novitas and First Coast, Medicare Administrative Contractors (MACs) that represent 12 states, also provided a positive update. They published draft local coverage determinations (LCDs) that proposed updated coverage criteria to include PDN. This includes PDN refractory to conventional medical management for SCS devices with an explicit FDA approval to treat PDN.
The LCDs — if finalized — mean Medicare patients in all 50 states will receive coverage for PDN. This would add approximately 17 million covered Medicare lives, according to a news release. The review for the proposed LCDs is ongoing with finalization dates yet to be determined.
Nevro said Aetna’s update adds to recent positive decisions from UnitedHealthcare, Blue Cross Blue Shield and Noridian. Altogether, these decisions increase coverage in the U.S. to approximately 54% of PDN patients. That represents a rise from approximately 25% at the end of 2021. If the MAC policies pan out, coverage rises to approximately 66%.
“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 10 kHz Therapy for PDN patients,” said D. Keith Grossman, chair, CEO and president of Nevro. “I am particularly pleased with the coverage decision by Aetna, who reconsidered its decision from earlier in the year and changed its SCS coverage policy to explicitly cover painful diabetic neuropathy.”
Redwood City, California–based Nevro develops the Senza 10 kHz high-frequency SCS system. Senza received FDA approval for treating chronic pain associated with PDN in July 2021. The company said then that Senza represents the only spinal cord stimulation system approved by the FDA with a specific indication for treating PDN.
States represented by Novitas and First Coast:
Arkansas, Colorado, Delaware, Florida, Louisiana, Maryland, Mississippi, New Jersey, New Mexico, Oklahoma, Pennsylvania and Texas.