SI-BONE’s iFuse: Exclusive Coverage Via HCSC

SI-BONE, Inc., an international company with U.S. headquarters in San Jose, California, has announced that Health Care Service Corporation (HCSC), an independent licensee of the Blue Cross and Blue Shield Association (BCBSA), has issued a positive medical policy exclusively for iFuse for MIS SI joint fusion. SI-BONE, makers of the iFuse Implant System, reports that this is the third private insurance company to issue a positive coverage policy for MIS SI joint fusion exclusively using iFuse; SelectHealth of Utah and Geisinger in Pennsylvania have already issues such policies.

According to the December 15, 2016 news release, “The policy summary states ‘based on professional societal organizations, literature reviews, in vitro studies, surveys, and cost-effective studies showing success and/or support for treating SIJ [sacroiliac joint] dysfunction with minimally invasive SIJ fusion, including a 2016 retrospective study group of patient surveys greater than 3 years, the evidence is sufficient to determine the effects of the technology on health outcomes. Therefore, minimally invasive SIJ fusion or stabilization, using titanium triangular implants or devices, for the treatment of back pain presumed to originate from the SIJ may be considered medically necessary when meeting all of the specific criteria.’”

As indicated by the company, “iFuse is the only SI joint fusion device in the U.S. with peer-reviewed publications detailing evidence from prospective trials, and is the only SI joint fusion device with a FDA-cleared indication citing clinical studies that demonstrate improvements in pain, patient function and quality of life.”

“The quality and quantity of clinical data supporting iFuse is compelling and was obviously a key element in enabling HCSC to establish exclusive coverage for iFuse, ” said Frank Phillips, M.D. of Midwest Orthopaedics at Rush in Chicago, Illinois. “Blue Cross Blue Shield patients make up a considerable part of my practice and now, those with SI joint pain caused by SI joint degeneration or disruption will have access to this clinically proven treatment.”

Dr. Phillips told OTW, “This is an important milestone for patients suffering from pain due to SI joint dysfunction. In recent years, carefully selected patients who were surgical candidates for SI joint fusion were unable to get treated because of reimbursement challenges and denials. This left many patients with no choice but to continue to rely on narcotic pain medications and other palliative and ineffective therapies. But now, BCBS patients who are surgical candidates in Texas, Illinois, Oklahoma, Montana and New Mexico will have access to iFuse, a clinically proven surgical treatment that can potentially enable them to return to a more normal lifestyle.”

“This is a significant step for surgeons in that we can now offer our patients a definitive surgical treatment for symptomatic SI joint degeneration or disruption. As a surgeon, telling patients that due to insurance issues there is nothing I can do to fix their problem when we both know a solution exists is frustrating and disheartening. I can now offer these patients the iFuse procedure that has been shown to be safe, effective, and durable, in high-level clinical trials.”