UnitedHealthcare to start covering medical implant for sleep apnea

By | July 14, 2019

Starting August 1, UnitedHealthcare is covering a specific therapy for obstructive sleep apnea, a medical implant developed by Inspire Medical Systems.

UnitedHealthcare’s policy will consider Inspire’s device to be medically necessary for the treatment of moderate to severe OSA when specified criteria are met–including a patient’s previous attempt at continuous positive airway pressure treatment and patient selection consistent with the FDA’s approval guidelines.

The hypoglossal nerve neurostimulation device was approved by the FDA in 2014. It is a small implanted system that senses breathing patterns and delivers mild stimulation to maintain multilevel airway patency during sleep.

Inspire said it’s a significant departure from traditional surgical treatments for sleep apnea, such as soft tissue surgery to the tonsils and palate.

WHY THIS MATTERS

UnitedHealthcare has specific coverage policies for treatment for obstructive sleep apnea. Removable oral appliances are considered medically necessary, while nasal dilator devices are not, according to an April medical policy.

As the largest health insurer covering more than 40 million members, UnitedHealthcare’s decision to expand coverage to a new treatment has great reach and benefits Inspire’s business. 

THE TREND

It’s estimated that nearly 30 million adults in the U.S. have OSA, and its prevalence continues to rise. The approach used by Inspire of stimulating the hypoglossal nerve has been praised by some in the medical community in recent years. For example, a 2018 paper by The Cleveland Clinic concluded that the hypoglossal nerve implantation “was far superior” to Uvulopalatopharyngoplasty (UPPP)–the mainstay of treatment for OSA.

ON THE RECORD

“As health plans continue to update their coverage policies to include Inspire therapy, an increasing number of patients and physicians will have access to our innovative therapy,” said Tim Herbert, president and chief executive officer of Inspire Medical Systems. “With the addition of UnitedHealthcare, we now have 35 coverage policies, representing approximately 125 million members, that cover Inspire therapy compared to 3 million members one year ago.”

Mark Klimek is an independent writer and editor with 20 years’ experience covering financial issues, healthcare and more.

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