Geisinger Health Plan, a commercial health plan covering more than 500,000 individuals in the US states of Delaware, Maine, New Jersey, Pennsylvania, and West Virginia has issued a revised medical policy for sacroiliac joint fusion that exclusively covers the iFuse implant system “for the treatment of sacroiliac joint syndrome and sacroiliac joint-mediated mechanical low back pain” when the five diagnostic criteria recommended by the International Society for the Advancement of Spine Surgery (ISASS) are met.
The policy became effective on June 15, 2016, and further states: “the use of minimally invasive fusion products other than iFuse implant system for sacroiliac joint fusion is considered experimental/investigational or unproven and therefore not covered.”
“Payors are increasingly requiring robust safety and effectiveness evidence, to include prospective and randomised controlled trials, which demonstrate significant patient improvement and long-term durability.” says Michael Mydra, vice president of Health Outcomes & Reimbursement at SI-Bone.
Matthew R Eager, a physician from Pennsylvania, says, “This decision provides an important treatment option for patients who fail to respond to non-surgical treatment for various sacroiliac joint conditions and will reduce the need for costly repeated interventions. I appreciate the health plans medical directors’ willingness to discuss this specific treatment with me and consider this important policy change.”