California Medicaid Adds TMS Access for 14.8 Million Adolescents and Adults
Neuronetics announced that California Medicaid (Medi-Cal) has added coverage for its NeuroStar TMS therapy for adolescents and adults aged 15 and older suffering from major depressive disorder (MDD).
This follows FDA clearance for NeuroStar TMS as a first-line add-on treatment for adolescents (15-21). The new policy, impacting 14.8 million people, takes effect on August 1, 2024.
In addition to Medi-Cal, Neuronetics recently secured TMS policy updates from BlueCross BlueShield of Michigan, Cambia Health, and Humana. NeuroStar TMS is the first and only FDA-cleared TMS therapy for adolescents, with a dedicated health policy team advocating for coverage expansions.
- Medi-Cal covers NeuroStar TMS for 14.8 million people.
- FDA clearance for NeuroStar TMS as a first-line add-on treatment for adolescents.
- Policy updates from BlueCross BlueShield of Michigan, Cambia Health, and Humana.
- None.
Insights
The addition of TMS (transcranial magnetic stimulation) coverage by Medi-Cal for adolescents and adults with major depressive disorder (MDD) is a significant development for Neuronetics, Inc. (NASDAQ: STIM). This move opens up a substantial new market for the company, potentially benefiting the company's revenue and profits. With Medi-Cal covering 14.8 million lives, the inclusion of TMS can drive increased utilization of NeuroStar TMS, expanding the company’s customer base.
From a financial perspective, this policy change can lead to a notable increase in recurring revenue as TMS therapy often requires multiple sessions. Additionally, the coverage aligns well with the company’s recent FDA clearance for adolescent use, creating a strategic advantage.
However, it's important to consider the cost implications and the time it will take to see the financial impact. The reimbursement rates from Medicaid programs can be lower compared to private insurers, which may affect profit margins. Long-term success will depend on adoption rates and whether the company can sustain its competitive edge, particularly as other players might seek similar FDA clearances.
From a medical research perspective, the inclusion of NeuroStar TMS in Medi-Cal is a significant step forward for mental health treatment. TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. FDA clearance for adolescents makes this treatment accessible at a critical age when early intervention can profoundly impact long-term mental health outcomes.
However, while the FDA has cleared TMS for this age group, it’s essential to keep an eye on long-term efficacy and safety data. The adoption of TMS will likely contribute to a growing body of evidence that could help refine treatment protocols and improve patient outcomes.
The policy's success will depend on how well healthcare providers integrate TMS into existing care models and how adolescents and their caregivers perceive and accept this treatment option. Education and training for providers will be important in ensuring effective and widespread use.
The addition of NeuroStar TMS to Medi-Cal’s coverage can significantly alter the competitive landscape of the mental health treatment market in California. Neuronetics, being the only company with FDA clearance for adolescents, stands to gain a first-mover advantage in this segment. This coverage can boost the company's market penetration and brand recognition.
However, the broader market dynamics need to be considered. Competitors are likely to seek FDA clearance for similar treatments, which may lead to increased competition. Hence, Neuronetics must continuously innovate and possibly expand its therapeutic offerings to maintain its lead.
This policy change will also catalyze the growth of TMS therapy as a mainstream treatment option, not just for severe cases but potentially as an add-on therapy for a broader patient base. Monitoring market response and the rate of adoption will provide insights into how well this move will translate into sustained growth for Neuronetics.
NeuroStar, the first and only TMS treatment cleared for adolescents, now covered by Medi-Cal
MALVERN, Pa., July 11, 2024 (GLOBE NEWSWIRE) -- Neuronetics, Inc. (NASDAQ: STIM), a medical technology company focused on designing, developing, and marketing products that improve the quality of life for patients who suffer from neurohealth disorders, announced that California Medicaid (Medi-Cal) has added TMS (transcranial magnetic stimulation) coverage for adults and adolescents aged 15 and older with MDD (major depressive disorder). This is the first policy from Medi-Cal that includes TMS, and the access follows the Company’s recent clearance from the U.S. Food and Drug Administration (FDA) for NeuroStar TMS as a first-line add-on treatment for adolescents aged 15-21.
Medi-Cal is California's Medicaid healthcare program. It offers no-cost and low-cost health coverage for children and adults with limited income and resources who meet eligibility requirements. Medi-Cal policies impact 14.8 million covered lives in California. The TMS policy update will go into effect on August 1, 2024.
“At a time when mental health services are more essential than ever, expanded access to NeuroStar TMS through Medi-Cal is a pivotal step in addressing the growing need for care among both adults and adolescents,” stated Keith J. Sullivan, President and CEO of Neuronetics, Inc. “NeuroStar’s Health Policy team is fully committed to collaborating with providers and payors on policy updates that enhance availability for those in need.”
Neuronetics recently announced TMS policy updates from BlueCross BlueShield (BCBS) of Michigan and Cambia Health, in addition to a previous announcement with a policy change from Humana to address TMS coverage for adolescents.
Neuronetics is the first and only TMS company with FDA clearance for the treatment of adolescents and the only company in the industry with a dedicated health policy team that partners with both providers and payors to advocate for health policy updates.
For more information about NeuroStar TMS Therapy, please visit www.neurostar.com.
About Adolescent Depression
Adolescent depression is a complex and challenging mental health condition that affects young individuals during the crucial period of adolescence. An estimated 4.3 million U.S. adolescents aged 15-21 are affected by MDDi. Depression amongst adolescents can disrupt crucial aspects of development, such as academic performance, relationships with peers and family members, and overall emotional well-being.
NeuroStar Advanced Therapy is indicated as an adjunct for the treatment of MDD in adolescent patients aged 15-21.
About Neuronetics
Neuronetics, Inc. believes that mental health is as important as physical health. As a global leader in neuroscience, Neuronetics is redefining patient and physician expectations with its NeuroStar Advanced Therapy for Mental Health. NeuroStar is a non-drug, noninvasive treatment that can improve the quality of life for people suffering from neurohealth conditions when traditional medication hasn’t helped. NeuroStar is indicated for the treatment of depressive episodes and for decreasing anxiety symptoms for those who may exhibit comorbid anxiety symptoms in adult patients suffering from MDD and who failed to achieve satisfactory improvement from previous antidepressant medication treatment in the current episode. It is also FDA-cleared as an adjunct for adults with obsessive-compulsive disorder and for adolescent patients aged 15-21 with MDD. NeuroStar Advanced Therapy is the leading TMS treatment for MDD in adults with over 6.4 million treatments delivered. Neuronetics is committed to transforming lives by offering an exceptional treatment that produces extraordinary results. For safety and prescribing information, visit www.neurostar.com.
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iWorld Health Organization, Depression Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/depression.
FAQ
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