After a review by its Medical Policy & Technology Assessment Committee, Anthem Blue Cross/Blue Shield updated its policy and added the Zimmer Biomet Mobi-C device implanted at one- and two-levels to what the plan considers medically necessary when a patient meets all the individual selection criteria.
The coverage went into effect on Aug. 18, 2016. Coverage by Anthem of one-level implantation of some other cervical disc prostheses has been in place since 2013.
The Anthem updated policy places the Mobi-C on the list of covered one-level disc replacement procedures and it establishes the Mobi-C device as the sole cervical total disc prosthesis on the list of devices covered for two-level surgery, according to information from Zimmer Biomet. The Bryan and Prestige discs, which are both manufactured by Medtronic, and the PCM Cervical Disc (NuVasive Inc.) and ProDisc-C Total Disc Replacement (DePuy Synthes) prostheses are the other implants listed by Anthem as covered for one-level procedures.
Jeffrey Zigler, JD, Zimmer Biomet senior director for market access, health economics and reimbursement, told Spine Surgery Today the 5-year results for the Mobi-C implant that were published and presented at scientific meetings recently provided the impetus for this policy update. He said Zimmer Biomet expects more plans to soon cover two-level contiguous cervical total disc replacement (TDR) performed with the Mobi-C device.
“There are a lot of Blue Cross/Blue Shield association plans that have yet to convert their one-level policies to two-level. We have a lot of confidence they will be evaluating the literature just like Anthem did and shifting their policy in favor of this therapy in the coming months,” Zigler said.
The thoroughness of the review by Anthem and the way it came out with its coverage decisions on a per-disc basis impressed Zigler. In 2013 only a handful of payers had stated cervical TDR coverage policies, Zigler noted.
“In 2016, we have had a doubling of the number of people [covered]. So, if at the end of 2015 there were more than 50 million people who had access to two-level procedures, now there are more than 100 million people [with that access] with this Anthem announcement,” Zigler said. –
Disclosure: Zigler reports he is a Zimmer Biomet employee and the son of spine surgeon Jack Zigler, MD.