More Positive Payor Determinations for Inspire Therapy, Including Additional 10.4 Million Covered Lives

Inspire Medical Systems Inc, a medical technology company that makes an implantable therapy for obstructive sleep apnea (OSA) and is focused on the development and commercialization of minimally invasive solutions for patients with the sleep disorder, reports the addition of 10.4 million covered lives to the growing positive coverage policies of Inspire therapy. Two new Blue Cross Blue Shield Association (“BCBSA”) plans, including the Blue Cross and Blue Shield (BCBS) Service Benefit Plan, also known as the Federal Employee Program (FEP), and BCBS of Tennessee have issued positive coverage policies of Inspire therapy. Additionally, Medical Mutual of Ohio also issued a positive coverage policy of Inspire therapy.

Details of the three new positive coverage policies include:

  • BCBS Service Benefit Plan, or FEP, covers approximately 5.3 million federal employees, retirees and their families across the United States and the policy became effective on April 1, 2019;
  • BCBS of Tennessee covers approximately 3.5 million members and becomes effective on May 22, 2019; and
  • Medical Mutual of Ohio covers approximately 1.6 million members and became effective on April 16, 2019.

There have now been 18 positive coverage policies issued by BCBSA healthcare plans, covering approximately 42 million members, following BCBSA Evidence Street’s January 7, 2019 report, which stated that there is sufficient evidence to determine that Inspire therapy results in a meaningful improvement in net health outcomes for patients meeting specified criteria. Beyond BCBSA, momentum continues with other payers with the Medical Mutual of Ohio being the latest example. In aggregate, 29 coverage policies representing approximately 72 million members now cover Inspire therapy.

“We are encouraged that to date, half of the 36 Blue Cross Blue Shield healthcare plans have issued positive coverage policies following the Evidence Street’s report,” says Tim Herbert, president and CEO of Inspire Medical Systems, in a release. “Improving access to Inspire therapy for the many patients with obstructive sleep apnea is a key initiative for our team. Our focus is to continue to build evidence to demonstrate the safety and efficacy of the therapy and these strong patient outcomes are expected to lead to further improvements in market access through additional coverage policies.”

from Sleep Review http://www.sleepreviewmag.com/2019/05/more-positive-payor-determinations-inspire/

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