A growing number of insurers plan to follow the advice of the Food and Drug Administration (FDA) and restrict the use of the laparoscopic power morcellator in hysterectomies, the Wall Street Journal reported.
Health Care Service Corp. (HCSC) is considering whether to deem the power morcellation procedure "not medically necessary," which would mean it's no longer eligible for coverage. The decision is open to public comment and will be made by June 1, according to the Journal. Aetna and Cigna are also reviewing their policies, the article said.
If the insurers do restrict morcellator use, they will join UnitedHealth, whose decision to require doctors to get prior authorization before performing most inpatient hysterectomies goes into effect today, FierceHealthPayer previously reported.
That decision drew the ire of gynecologists, who said they felt the choice regarding what type of hysterectomy to perform, and what type of equipment to use, was best made by a patient and her doctor, not a third-party administrator.
However, the FDA warned in November that physicians shouldn't use morcellator devices on a vast majority of women, the Journal said. The device uses a fast-spinning blade to remove benign growths called fibriods--but in women who have uterine sarcoma, a procedure using a morcellator could disperse the cancer into the abdominal cavity.
Payer restrictions on morcellator use have emerged only in the months since the FDA aired its safety concerns, Karen Ignagni, president and chief executive of America's Health Insurance Plans, told the Journal. Payers now must consider whether to halt altogether or simply restrict morcellator use, recognizing that it remains a minimally invasive option for hysterectomies.
Among major insurers, UnitedHealth and Anthem require prior authorization for morcellator use. Highmark, Blue Cross Blue Shield of Massachusetts and AmeriHealth Caritas are among the payers who have ceased coverage of procedures that use a morcellator.
- here's the Wall Street Journal article
UnitedHealth hysterectomy decision pits payers against providers
Anthem uses Watson to speed up pre-approval process