SI-BONE, Inc. has announced that Highmark, Inc., the nation’s 4th largest Blue Cross and Blue Shield-affiliated insurer, has approved coverage—exclusively—for SI-BONE’s iFuse, MIS (minimally invasive surgery) SI (sacroiliac) joint fusion system.
Highmark Insurance: Coverage Approved for iFuse System
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As the San Jose, California-based company wrote in its August 23, 2017 news release; “Based on the more than 50 peer-reviewed clinical studies and publications, the policy, provides iFuse coverage for more than 4.5 million Blue Cross Blue Shield [BCBS] plan members in Pennsylvania, Delaware and West Virginia effective August 21, 2017. Over 22.5 million BCBS health plan members are now covered for MIS SI joint fusion.”
The Following Blue Cross Blue Shield Plans now cover iFuse:
- BCBS of Texas: HCSC: Exclusive to iFuse
- BCBS of Oklahoma: HCSC: Exclusive to iFuse
- BCBS of New Mexico: HCSC: Exclusive to iFuse
- BCBS of Montana: HCSC: Exclusive to iFuse
- BCBS of Illinois: HCSC: Exclusive to iFuse
- BCBS of Pennsylvania: Highmark: Exclusive to iFuse
- BCBS of Delaware: Highmark: Exclusive to iFuse
- BCBS of West Virginia: Highmark: Exclusive to iFuse
- BCBS of Michigan
- BCBS of Vermont
- BCBS of Nebraska
“The SI joint is a common source of low back pain in many patients. I have performed over 90 procedures with the iFuse Implant System and it has been a rewarding procedure for my patients and for me as a spine surgeon. I am very pleased to now be able to offer appropriately diagnosed Blue Cross Blue Shield patients this clinically proven SI joint fusion procedure,” said Michael Oh, M.D., neurosurgeon at Allegheny General Hospital in Pittsburgh, Pennsylvania.
Jeffrey Dunn, president, chairman and CEO at SI-BONE.” told OTW, “Our goal is to obtain positive coverage for the iFuse Implant System with every commercial payor in the United States so that all SI joint surgical patients may benefit. For close to 10 years, since the iFuse Implant was first introduced in November of 2008, we have invested in education and clinical research.”
“The result from those investments is over 50 peer-reviewed publications clearly demonstrating clinical safety, effectiveness, durability and economic benefit of the iFuse Implant and over 27,000 procedures performed by over 1,000 surgeons.”
“Our industry leading clinical evidence has enabled us to secure coverage for Medicare beneficiaries in all 50 states and we are now beginning to obtain exclusive positive coverage policies with some of the largest commercial payors in the U.S. We are committed to continuing our efforts to educate payors on the clinical and economic benefits of the iFuse Implant System so that all SI joint surgical candidates may have access to this potentially life changing treatment regardless of where they live or what health care coverage they have.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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