Blue Cross of Idaho has issued a positive coverage policy of Inspire Medical Systems Inc’s Inspire upper airway stimulation therapy for obstructive sleep apnea. This is the first coverage policy issued following BCBS Evidence Street’s January 7, 2019 report, which stated there is sufficient evidence to determine that Inspire therapy results in a meaningful improvement in net health outcomes for patients meeting specified criteria.
Blue Cross of Idaho is a not-for-profit mutual insurance company covering approximately 500,000 members. Blue Cross of Idaho is an independent licensee of the Blue Cross and Blue Shield Association (BCBSA). The Blue Cross of Idaho policy is effective March 20, 2019. This policy has a few changes from the Evidence Street summary including a BMI of less than 32. This Blue Cross of Idaho is the first policy to include coverage for adolescents who have Down’s syndrome. It is important to note that this indication is not yet approved by the FDA.
In addition to Blue Cross of Idaho, an additional positive coverage policy became effective January 1, 2019 with Ascension Smart Health. These positive coverage decisions are a result of the large and growing body of clinical evidence supporting the use of Inspire therapy for the treatment of moderate to severe obstructive sleep apnea.
Ascension Smart Health is the self-funded medical plan offered to associates of select Ascension entities and their eligible dependents. Ascension is the largest non-profit health system in the United States and the world’s largest Catholic health system and includes approximately 156,000 associates plus 34,000 aligned providers and over 2,600 sites of care in 22 states and the District of Columbia. The Ascension SmartHealth policy became effective on January 1, 2019.
“Following the Evidence Street summary this past week, we are very pleased to have the positive coverage decision from Blue Cross of Idaho in such a short time period. We will continue to work with physicians and treatment centers to develop additional positive coverage policies with the regional BCBS systems,” says Tim Herbert, president and CEO of Inspire Medical Systems, in a release. “We also plan to build on our already strong body of clinical data supporting Inspire therapy and believe this clinical and real-world data will further result in coverage decisions by other major health plans and further adoption of Inspire therapy.”
The BCBSA’s Evidence Street platform provides health care decision-makers easy access to impartial medical evidence reviews for devices, diagnostics, and pharmaceuticals and was created to make BCBSA’s evidence review process of medical technologies and therapies more transparent, efficient, and comprehensive. BCBSA collects and analyzes available peer-reviewed evidence, then synthesizes that data and ascertains if the evidence is sufficient or insufficient to determine the effect on health outcomes.
from Sleep Review http://www.sleepreviewmag.com/2019/01/blue-cross-idaho-positive-coverage-policy-inspire-therapy/