Highmark issued a positive coverage policy decision for interspinous and interlaminar stabilization and distraction using Paradigm Spine's coflex on Nov. 6.
Here are four things to know:
1. Highmark became the first private payer to issue an exclusive positive coverage policy for coflex interlaminar stabilization to treat lumbar spinal stenosis. Lumbar spinal stenosis affects 1.6 million individuals in the U.S. per year.
2. Medicare coverage policies issued by Highmark and affiliates cover 5 million members in Pennsylvania, West Virginia and Delaware as the 4th largest Blue Cross Blue Shield-affiliated organization. Those members now have access to coflex.
3. The medical policy specifically excludes any other interspinous distraction or interlaminar stabilization devices from coverage, except for coflex. More than 85 peer-reviewed articles support the safety and effectiveness of coflex.
4. The coflex devices is a non-fusion, motion preserving stabilization implant with FDA pre-market approval status for treating lumbar spinal stenosis. The device has a 20 year clinical history and is used in more than 40 countries worldwide.
"The coflex procedures is often an outpatient, non-fusion procedure that allows for fast recovery, and a high quality functionally active lifestyle for my patients," said J. Rush Fisher, MD, chief of the spine section at Delaware-based Christiana Care Health Services. "I'm understandably pleased that insurance coverage will now be available to more of my patients."