SI-BONE, Inc. Announces that Humana Establishes Exclusive Coverage for iFuse in MIS SI Joint Fusion Procedures

Rhea-AI Summary

SI-BONE, Inc. (SIBN) announced that Humana, one of the largest U.S. commercial payers, has revised its coverage policy to include minimally invasive sacroiliac joint fusion using the iFuse Implant System. This update, effective December 10, 2020, allows coverage for chronic low back pain due to sacroiliac joint dysfunction, contingent on meeting specific criteria. Humana joins 36 other health plans covering iFuse procedures, which are supported by multiple clinical studies demonstrating efficacy in pain relief and improved quality of life.

Positive

• Humana's coverage approval for iFuse Implant System is expected to expand the market for SI-BONE.
• The new policy aligns with guidelines from professional spine societies, enhancing clinical credibility.
• There is a growing body of evidence supporting the iFuse Implant, with over 85 peer-reviewed studies.

Negative

• None.

Humana is one of the 5 largest commercial payors in the U.S. and joins 36 other commercial health plans that offer coverage for the triangular iFuse Implant System only

SANTA CLARA, Calif., Dec. 16, 2020 (GLOBE NEWSWIRE) -- SI-BONE, Inc., (Nasdaq: SIBN) a Silicon Valley-based medical device company dedicated to solving musculoskeletal disorders of the sacro-pelvic anatomy, today announced that Humana has revised its coverage policies to cover minimally invasive SI joint fusion using triangular titanium implants (i.e., iFuse Implant System). Humana is one of the five largest commercial payers in the U.S., with over 12.7 million covered lives.

The revised policy, effective for procedures performed as of December 10, 2020, provides coverage for minimally invasive sacroiliac joint fusion for chronic low back pain due to sacroiliac joint dysfunction, provided certain criteria are met. The new coverage criteria, found in the revised Spinal Fusion Surgery policy, can be found here (link).

“We are thrilled with Humana’s decision to cover MIS SI joint fusion procedures that use iFuse for its members, and with clinical criteria that aligns closely with guidelines from professional spine societies like NASS and ISASS,” said Jeffrey Dunn, President, Chief Executive Officer, and Chairman 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 culture. With this updated policy, Humana joins 36 other health plans that cover MIS SI joint fusion using the iFuse Implant System exclusively, as well as other large payors including United Healthcare, CIGNA and Aetna, which also provide positive coverage for iFuse procedures.”

About SI-BONE, Inc.
SI-BONE is a medical device company that pioneered minimally invasive surgery of the SI joint with the iFuse Implant System. Studies have shown that the SI joint can be a source of pain in 15% to 30% of chronic low back pain. The iFuse Implant™, commercially available since 2009, is the only SI joint fusion device supported by multiple prospective clinical studies, including two randomized controlled trials, showing improved pain, patient function and quality of life resulting from treatment. There are over 85 peer-reviewed publications demonstrating the safety, durable effectiveness, and biomechanical and economic benefits unique to the iFuse Implant (www.si-bone.com/results). This body of evidence 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.

The iFuse Implant System is intended for sacroiliac fusion for conditions including sacroiliac joint dysfunction that is a direct result of sacroiliac joint disruption and degenerative sacroiliitis. This includes conditions whose symptoms began during pregnancy or in the peripartum period and have persisted postpartum for more than 6 months. The iFuse Implant System is also intended for sacroiliac fusion to augment stabilization and immobilization of the sacroiliac joint in skeletally mature patients undergoing sacropelvic fixation as part of a lumbar or thoracolumbar fusion. In addition, the iFuse Implant System is intended for sacroiliac fusion in acute, non-acute, and non-traumatic fractures involving the sacroiliac joint. There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit.

SI-BONE and iFuse Implant System are registered trademarks of SI-BONE, Inc. ©2020 SI-BONE, Inc. All Rights Reserved. 12162020

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 is the significance of Humana's coverage decision for SI-BONE (SIBN)?

Humana's decision to cover the iFuse Implant System is significant as it opens up access for patients suffering from chronic low back pain due to sacroiliac joint dysfunction, potentially increasing sales and market share for SI-BONE.

What are the criteria for Humana's coverage of the iFuse Implant System?

The coverage criteria for Humana's policy can be found in their revised Spinal Fusion Surgery policy, which stipulates specific requirements that must be met for coverage.

How many health plans cover the iFuse Implant System after Humana's decision?

With Humana's inclusion, a total of 37 health plans now cover the iFuse Implant System for minimally invasive sacroiliac joint fusion.

When did Humana's new coverage policy for the iFuse Implant System take effect?

The revised coverage policy by Humana took effect for procedures performed as of December 10, 2020.

What does the iFuse Implant System treat?

The iFuse Implant System is designed to treat sacroiliac joint dysfunction and related conditions, providing a minimally invasive option for patients.