UnitedHealthcare’s New Positive Medical Policy in Favor of Lumbar Total Disc Replacement Reconfirms the Procedure’s Long-Term Effectiveness and Value for the Treatment of Degenerative Disc Disease

PR Newswire

CENTER VALLEY, Pa., July 3, 2018 /PRNewswire/ -- Aesculap Implant Systems, LLC today announced that UnitedHealthcare^® has issued a new, positive medical policy for Lumbar Total Disc Replacement (TDR). UnitedHealthcare will cover Lumbar TDR for single-level degenerative disc disease. This change means that millions of patients in virtually every state in the country will now have access to the procedure, taking total commercial insurance coverage in the United States to almost 65 percent.

activL Artificial Disc with Intelligent Motion Technology

"I like to think my case was part of the change," said recent activL^® Artificial Disc patient and UnitedHealthcare customer Carrie Guthrie, now of Washington state, who had her Lumbar TDR procedure in Atlanta with Dr. Tapan Daftari of the Resurgens group. Guthrie, who invested in the three-month external appeal process to fight UnitedHealthcare's denial of her case, is now living pain free. "When the activL Patient Assistance Line helped to get the approval of the Lumbar Disc Replacement, I could not have predicted how the surgery would alter my life," said Guthrie. "Living with severe daily pain year after year had changed my perception of life; it had dulled my ability to enjoy anything."

Guthrie gained access to the activL Artificial Disc by leveraging her external review rights as afforded to her by the Affordable Care Act. By exercising her rights to the external review process, UnitedHealthcare had to send her case to an independent third party to determine if her case was medically necessary. Stakeholders believe that cases like Guthrie's were an essential factor in UnitedHealthcare's decision to overturn their negative policy.

"We are thankful for patients like Carrie Guthrie who are willing to put the evidence in front of non-covering payers and help them understand why Lumbar TDR should be an option," said Kim Norton, who leads Aesculap's payer policy and reimbursement efforts. "UnitedHealthcare will begin covering because patients have helped them to see that there is a demand for this procedure, and the patients do well after receiving it," continued Norton.

"We invested in a comprehensive evidence development and payer policy strategy at Aesculap because we know how strong our long-term activL Artificial Disc outcomes are. We saw the unmet need, and we wanted to focus our resources on important initiatives like helping patients with Degenerative Disc Disease," said Chuck DiNardo, President of Aesculap Implant Systems. "We all knew that with the evidence and through the work of our Patient Assistance Line, US payers would want to extend access to Lumbar TDR to their customers, our patients. We are pleased that payers are giving the data consideration."

This announcement comes weeks after the US Military's TRICARE health plan also announced coverage and after numerous BlueCross BlueShield plans have decided to cover. The remaining patients with non-covering health plans include primarily a few BlueCross BlueShield plans, as well as Aetna, a large national insurer which had a positive coverage policy for Lumbar TDR and dissolved it as part of a merger with a different plan in 2012.

The activL Artificial Disc is a third generation motion preservation device designed to more closely mimic the natural biomechanics of the healthy human spine, thereby significantly reducing the impact on adjacent level anatomy. The five-year clinical outcomes were recently presented at the North American Spine Society (Orlando, FL, October 25-28, 2017) meeting and will be presented at EuroSpine 2018 (Barcelona, Spain, September 19-21, 2018). The radiographic outcomes were published in Spine (https://journals.lww.com/spinejournal/Abstract/publishahead/Progression_of_Adjacent_level_Degeneration_After.95075.aspx).

If you are a Degenerative Disc Disease sufferer interested in understanding your spinal fusion alternative options or if you need help navigating the Lumbar TDR insurance landscape, visit https://www.soactivesofast.com/low-back/activl-artificial-disc or call 1-844-245-1140.

About Aesculap Implant Systems, LLC
Aesculap Implant Systems, LLC, a B. Braun company, is part of a 175-year-old global organization focused on meeting the needs of the changing healthcare environment. Through close collaboration with its customers, Aesculap Implant Systems develops advanced spine and orthopaedic implant technologies to treat complex disorders of the spine, hip and knee. Aesculap Implant Systems strives to deliver products and services that improve the quality of patients' lives. For more information, call 800-234-9179 or visit aesculapimplantsystems.com.