Helius Medical Technologies, Inc. Announces Third-Party Reimbursement for PoNS® from Major Insurance Carrier
Helius Medical Technologies announced that it secured its first third-party reimbursement for its Portable Neuromodulation Stimulator (PoNS) device from a major insurance carrier. The reimbursement rate is set at $23,900, slightly below the list price due to a 7% rebate. This milestone follows the Centers for Medicare & Medicaid Services’ (CMS) establishment of unique codes for the PoNS mouthpiece and controller. Helius is actively negotiating with additional third-party payers and assisting multiple sclerosis (MS) patients in submitting claims. The reimbursed rate is broken down to $16,554 for the controller and $7,347 for the mouthpiece.
- Secured first third-party reimbursement for PoNS device.
- Reimbursement rate is $23,900, close to list price.
- Established unique coding for PoNS with CMS.
- Actively negotiating with additional third-party payers.
- Assisting MS patients in claims submissions.
- Reimbursement rate includes a 7% rebate, lowering the final amount received.
- No confirmed reimbursement deals with other third-party payers yet.
Insights
The news of third-party reimbursement from a major insurance carrier for Helius Medical Technologies' PoNS® device is a notable financial milestone. Reimbursement at a rate of $23,900, slightly below the list price, indicates solid negotiating capabilities and market acceptance. For investors, this suggests potential revenue stability and growth as broader insurance coverage can lead to increased sales volume.
Moreover, Helius' ability to secure unique Healthcare Common Procedure Coding System (HCPCS) codes and collaborate with organizations like the Veterans Administration and the Department of Defense suggests strong strategic positioning in the healthcare reimbursement landscape. This development could enhance Helius' market share and competitive advantage in the neurotech space.
However, investors should also consider the potential pricing pressure from competing products and the need for ongoing negotiations with other third-party payers. The 7% rebate, while relatively modest, still impacts the net reimbursement rate and might influence profit margins. Long-term, the ability of Helius to secure similar or better reimbursement terms with other insurers will be important for sustained financial performance.
The reimbursement for Helius' PoNS® device signifies validation of its clinical efficacy and utility in treating balance and gait deficits. This can encourage physicians to consider PoNS® as a viable treatment option, enhancing adoption rates. Importantly, securing insurance coverage makes the device more accessible to patients, which can drive broader clinical acceptance and utilization.
Additionally, the unique HCPCS codes for the PoNS mouthpiece and controller demonstrate regulatory recognition, which can streamline the coding and billing process in clinical settings. This can lead to more straightforward integration of PoNS® into treatment protocols for conditions like multiple sclerosis, where balance and gait issues are common.
Overall, this development could spur further clinical research and potential new indications for PoNS®, enhancing its value proposition. However, continued clinical validation and post-market surveillance will be necessary to maintain confidence in its therapeutic benefits.
The announcement of third-party reimbursement is a strong signal of market penetration for Helius' PoNS® device. Insurance coverage often acts as a catalyst for wider adoption, as it reduces out-of-pocket expenses for patients, making the device more accessible. This can lead to increased market acceptance and potentially higher sales volumes.
The reimbursement rate, despite a 7% rebate, being near the list price, shows that there is perceived value in the device from a payer's perspective. This could set a benchmark for negotiations with other insurers and facilitate the establishment of consistent reimbursement rates across different insurance carriers.
However, market dynamics such as the presence of competing neurostimulation devices, patient awareness and the overall treatment ecosystem should be closely monitored. The success of PoNS® in the market will depend on Helius' ability to differentiate its product and demonstrate clear value to both healthcare providers and patients.
-- Reimbursement at
-- Represents a significant milestone toward increasing accessibility of PoNS --
NEWTOWN, Pa., May 29, 2024 (GLOBE NEWSWIRE) -- Helius Medical Technologies, Inc. (Nasdaq:HSDT) (“Helius” or the “Company”), a neurotech company focused on delivering a novel therapeutic neuromodulation approach for balance and gait deficits, today announced the first third-party reimbursement from a major insurance carrier for the Company’s Portable Neuromodulation Stimulator (PoNS®) device.
“Securing widespread reimbursement for PoNS remains a top priority for us, and we are thrilled to announce that we’ve received our first third-party reimbursement for this innovative device at the list price with a
“We believe this is yet another important milestone in establishing the market pricing for PoNS as we continue to negotiate with other third-party payers and CMS. In addition, we are assisting several MS patients who have or are preparing to submit claims with other third-party payers and look forward to establishing reimbursement rates with those carriers as we move forward,” concluded Andreeff.
The reimbursed rate, net of a
About Helius Medical Technologies, Inc.
Helius Medical Technologies is a leading neurotech company in the medical device field focused on neurologic deficits using an orally applied technology platform that amplifies the brain’s ability to engage physiologic compensatory mechanisms and promote neuroplasticity, improving the lives of people dealing with neurologic diseases. The Company’s first commercial product is the Portable Neuromodulation Stimulator. For more information about the PoNS® or Helius Medical Technologies, visit www.heliusmedical.com.
About the PoNS Device and PoNS Therapy
The Portable Neuromodulation Stimulator (PoNS) is an innovative, non-implantable, orally applied therapy that delivers neurostimulation through a mouthpiece connected to a controller and it’s used, primarily at home, with physical rehabilitation exercise, to improve balance and gait. The PoNS device, which delivers mild electrical impulses to the tongue, is indicated for use in the United States as a short-term treatment of gait deficit due to mild-to-moderate symptoms from multiple sclerosis (“MS”) and is to be used as an adjunct to a supervised therapeutic exercise program in patients 22 years of age and over by prescription only.
PoNS has shown effectiveness in treating gait or balance and a significant reduction in the risk of falling in stroke patients in Canada, where it received authorization for sale in three indications: (i) for use as a short-term treatment (14 weeks) of gait deficit due to mild and moderate symptoms from stroke and is to be used in conjunction with physical therapy; (ii) for use as a short-term treatment (14 weeks) of chronic balance deficit due to mild-to-moderate traumatic brain injury (“mmTBI”) and is to be used in conjunction with physical therapy; and (iii) for use as a short-term treatment (14 weeks) of gait deficit due to mild and moderate symptoms from MS and is to be used in conjunction with physical therapy. PoNS is also authorized for sale in Australia for short term use by healthcare professionals as an adjunct to a therapeutic exercise program to improve balance and gait. For more information visit www.ponstherapy.com.
Cautionary Disclaimer Statement
Certain statements in this news release are not based on historical facts and constitute forward-looking statements or forward-looking information within the meaning of the U.S. Private Securities Litigation Reform Act of 1995 and Canadian securities laws. All statements other than statements of historical fact included in this news release are forward-looking statements that involve risks and uncertainties. Forward-looking statements are often identified by terms such as “believe,” “expect,” “continue,” “will,” “goal,” “aim” and similar expressions. Such forward-looking statements include, among others, statements regarding the Company’s ability to negotiate acceptable reimbursement rates with additional third-party payers, the potential for patients to submit additional claims with other third-party payers, and the uses and effectiveness of PoNS and PoNS Therapy.
There can be no assurance that such statements will prove to be accurate and actual results and future events could differ materially from those expressed or implied by such statements. Important factors that could cause actual results to differ materially from the Company’s expectations include uncertainties associated with the Company’s capital requirements to achieve its business objectives, availability of funds, the Company’s ability to find additional sources of funding, manufacturing, labor shortage and supply chain risks, including risks related to manufacturing delays, the Company’s ability to obtain national Medicare insurance coverage and negotiate reimbursement with other third-party payers, the Company’s ability to continue to build internal commercial infrastructure, secure state distribution licenses, market awareness of the PoNS device, future clinical trials and the clinical development process, the product development process and the FDA regulatory submission review and approval process, other development activities, ongoing government regulation, and other risks detailed from time to time in the “Risk Factors” section of the Company’s Annual Report on Form 10-K for the year ended December 31, 2023, and its other filings with the United States Securities and Exchange Commission and the Canadian securities regulators, which can be obtained from either at www.sec.gov or www.sedar.com.
The reader is cautioned not to place undue reliance on any forward-looking statement. The forward-looking statements contained in this news release are made as of the date of this news release and the Company assumes no obligation to update any forward-looking statement or to update the reasons why actual results could differ from such statements except to the extent required by law.
Investor Relations Contact
Lisa M. Wilson, In-Site Communications, Inc.
T: 212-452-2793
E: lwilson@insitecony.com
FAQ
What was the reimbursement rate secured by Helius Medical Technologies for the PoNS device?
Who provided the first third-party reimbursement for Helius' PoNS device?
What is the breakdown of the reimbursed rate for the PoNS device?
What codes were established by CMS for the PoNS device?
Is Helius Medical Technologies negotiating with other third-party payers?
What is the stock symbol for Helius Medical Technologies?
