SI-BONE, Inc. Announces Anthem, Inc. Adopts Coverage Guidelines for Sacroiliac Joint Fusion Exclusive to the Triangular iFuse Implant System® for Its More Than 40 Million Members

Rhea-AI Summary

SI-BONE, Inc. (Nasdaq: SIBN) announced that Anthem, America's 2nd largest health insurer, will cover minimally invasive SI joint fusion exclusively with the iFuse Implant System. This new policy, effective from July 30, 2021, provides virtually universal coverage for chronic sacroiliac joint pain, contingent on specific criteria. Anthem has adopted clinical guidelines from AIM Specialty Health, aligning coverage with current medical practices and supporting the iFuse system backed by multiple clinical trials. This marks a significant step for patient access and positions SI-BONE favorably within the competitive health insurance landscape.

Positive

• Anthem's coverage provides virtually universal access to the iFuse Implant System, potentially increasing market penetration.
• The alignment with AIM Specialty Health enhances the credibility and acceptance of the iFuse procedure among insurers.
• The policy reflects positive outcomes from multiple Level I and Level II clinical trials, reinforcing SI-BONE's strategy to leverage high-quality evidence.

Negative

• None.

Anthem is America’s 2nd largest commercial health insurer and joins more than 35 other health plans to offer coverage exclusively for the triangular iFuse Implant System

SANTA CLARA, Calif., Aug. 02, 2021 (GLOBE NEWSWIRE) -- SI-BONE, Inc., (Nasdaq: SIBN) a Silicon Valley-based medical device company dedicated to solving musculoskeletal disorders of the sacropelvic anatomy, today announced that Anthem, Inc. will cover minimally invasive SI joint fusion exclusively when performed with the iFuse system of triangular titanium implants. Anthem has adopted coverage guidelines from AIM Specialty Health, a subsidiary specialty benefit management company with medical necessity guidelines that support minimally invasive SI joint fusion only when iFuse implants (titanium triangular implants) are used.

The new policy provides coverage for chronic sacroiliac joint pain and functional impairment, provided certain criteria are met, resulting in virtually universal coverage for the iFuse Implant System.

Anthem’s adoption of AIM guidelines for its members can be found here: https://aimspecialtyhealth.com/anthem185/musculoskeletal.

The link to the new guidelines for medical necessity of iFuse procedures can be found here: https://aimspecialtyhealth.com/wp-content/uploads/2020/08/AIM_Guidelines_MSK_Sacroiliac_Joint_Fusion.pdf

The new policy will be implemented across Anthem’s family of health plans beginning July 30, 2021. The AIM clinical appropriateness guidelines for sacroiliac joint fusion provide clearer guidance for broader access to the iFuse Implant System for Anthem’s more than 40 million members throughout the U.S.

“We are pleased with Anthem’s decision to adopt clinical appropriateness guidelines for minimally invasive SI joint fusion that more closely align with current medical practice, and which reflect the multiple Level I and Level II clinical trials of the iFuse Implant System,” said Laura Francis, Chief Executive Officer at SI-BONE. “Payors continue to rely on long-term outcomes from high-quality randomized controlled trials when establishing coverage criteria for new treatments which is a cornerstone of our strategy. With this updated policy, Anthem joins other large payors including United Healthcare, CIGNA, Humana, Aetna and Centene, to provide positive coverage for iFuse, which is great news for the millions of Anthem plan members.”

About SI-BONE, Inc.

SI-BONE (NASDAQ: SIBN) is a global leader in technology for surgical treatment of musculoskeletal disorders of the sacropelvic anatomy. In 2009, SI-BONE introduced the iFuse Implant System for minimally invasive surgery of the SI joint, shown to be a source of pain in 15% to 30% of chronic low back pain. Since then, more than 2,400 surgeons have performed a combined total of more than 55,000 SI joint fusion procedures. A unique body of evidence, supporting the iFuse Implant System, including two RCT’s and over 95 peer reviewed publications, has enabled multiple government and private insurance payors to establish coverage of the SI joint fusion procedure exclusively when performed with the iFuse Implant System. SI-BONE is leveraging its market leadership position, supported by this proprietary reimbursement advantage, to commercialize other devices intended for surgical treatment of related aspects of the human anatomy. For more information or to join our team, please visit us at www.si-bone.com.

For additional information on the company or the products including risks and benefits, please visit www.si-bone.com.

SI-BONE and iFuse Implant System are registered trademarks of SI-BONE, Inc. ©2021 SI-BONE, Inc. All Rights Reserved.

Media Contact:
Joe Powers, Vice President of Marketing
jpowers@si-bone.com
669-205-2521

Investor Contact:
Matt Bacso
investors@SI-BONE.com

FAQ

What recent coverage decision did Anthem make regarding SI-BONE's iFuse Implant System?

Anthem announced it will cover minimally invasive SI joint fusion exclusively using the iFuse Implant System, effective July 30, 2021.

How does Anthem's coverage of the iFuse Implant System impact SI-BONE?

The coverage decision significantly enhances patient access to SI-BONE's iFuse system, potentially leading to increased sales and market share.

What are the criteria for coverage of the iFuse Implant System by Anthem?

Coverage for the iFuse Implant System is provided for chronic sacroiliac joint pain and functional impairment, subject to meeting specific medical necessity guidelines.

How does this new policy affect SI-BONE's shareholders?

The policy is positive for shareholders as it indicates expanded market access, which may lead to increased revenue opportunities.

When will Anthem's new policy on iFuse Implant System coverage take effect?

The new policy will be implemented across Anthem’s health plans starting July 30, 2021.