SI-BONE, Inc. Announces UnitedHealthcare Adopts Exclusive iFuse Only Coverage for Minimally Invasive SI Joint Fusion

Rhea-AI Summary

SI-BONE, Inc. announced that UnitedHealthcare will exclusively cover its iFuse triangular implants for minimally invasive SI joint fusion procedures, effective October 1, 2021. This change highlights a shift from covering all devices to a specific preference for iFuse implants, supported by over 100 peer-reviewed publications and more than 60,000 iFuse procedures performed. With coverage from UnitedHealthcare, which has over 45 million members, and other major insurers, the policy aims to enhance patient access to effective treatment for degenerative SI joint disease.

Positive

• UnitedHealthcare's exclusive coverage of the iFuse implant improves patient access.
• The decision reflects a rigorous evidence base with over 100 peer-reviewed publications.
• Over 60,000 successful iFuse procedures performed by more than 2,500 surgeons globally.

Negative

• None.

The transition to an exclusive triangular implant policy by UnitedHealthcare, the nation’s largest health insurer, is supported by over 100+ peer-reviewed publications, and comes as SI-BONE surpasses 60,000 iFuse procedures performed by more than 2,500 surgeons worldwide

SANTA CLARA, Calif., Oct. 11, 2021 (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 UnitedHealthcare has changed its minimally invasive SI joint fusion policy from covering all devices to exclusively covering SI-BONE’s triangular iFuse Implants, effective October 1, 2021. UnitedHealthcare has adopted InterQual Clinical Criteria for Sacroiliac Joint Interventions, updating its policies to cover minimally invasive SI joint fusion using a Titanium Triangular Implant (i.e., iFuse Implant System). UnitedHealthcare is the largest commercial payor in the U.S. with over 45 million members, and joins Anthem, Humana and many Blue Cross Blue Shield Association health plans in requiring use of the triangular iFuse Implant System for minimally invasive SI joint fusion. With this updated policy, UnitedHealthcare joins more than 35 other health plans that collectively cover over 160 million insured, requiring the use of the iFuse Implant System for minimally invasive SI joint fusion. Nearly all other U.S. insurers now cover the procedure, generally.

The revised policy provides coverage for minimally invasive sacroiliac joint fusion for the treatment of painful degenerative SI joint disease, provided certain criteria are met. Until now, UnitedHealthcare has generally covered minimally invasive SI joint fusion procedures, but has not distinguished the implant type used. The new commercial policy bulletin on minimally invasive SI joint fusion can be found here (link). This policy change follows a recent decision by Anthem, Inc., the nation’s second largest national insurer, that transitioned its MIS SI joint fusion medical policy to AIM Specialty Health, also requiring use of titanium triangular implants exclusively for SI joint fusion procedures effective July 30, 2021 (link).

“UnitedHealthcare’s evidence-driven decision to cover minimally invasive SI joint fusion procedures only when using triangular titanium implants is an important step for improving patients’ access to the iFuse procedure,” said Carlton Reckling, MD, Chief Medical Officer and Vice President, Medical Affairs at SI-BONE. “The InterQual clinical criteria reflect the high level of rigorous study associated with the iFuse Implant System, and are aligned with clinical criteria from NASS, ISASS and numerous other organizations. UnitedHealthcare’s decision follows numerous other insurers that have adopted specialty benefits management companies’ criteria, including eviCore, AIM Specialty Health, and Hayes, which have positive assessments of the evidence supporting the iFuse procedure.”

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 2,500 surgeons have performed a combined total of more than 60,000 SI joint fusion procedures. A unique body of evidence, supporting the iFuse Implant System, including two RCT’s and over 100 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

Investor Contact:
Matt Bacso
investors@si-bone.com

FAQ

What recent policy change did UnitedHealthcare make regarding SI joint fusion procedures?

UnitedHealthcare has changed its policy to exclusively cover SI-BONE's iFuse triangular implants for minimally invasive SI joint fusion, effective October 1, 2021.

How many iFuse procedures have been performed?

More than 60,000 iFuse procedures have been performed worldwide by over 2,500 surgeons.

Why is UnitedHealthcare's decision significant for SI-BONE (SIBN)?

The decision is significant as it enhances patient access to the iFuse procedure and solidifies SI-BONE's competitive advantage in the market.

How does the new policy by UnitedHealthcare impact coverage for SI joint fusion?

The new policy restricts coverage to only the iFuse titanium triangular implants for SI joint fusion procedures, affecting treatment options.

What is the market impact of UnitedHealthcare's policy on SIBN?

UnitedHealthcare's policy may lead to increased demand for iFuse implants, potentially boosting SI-BONE's market position and sales.