Nevro Comments on UnitedHealthcare Medical Coverage Policy Update

  Nevro Corp. (NYSE: NVRO), a global medical device company that is delivering comprehensive, life-changing solutions for the treatment of chronic pain, today announced that on October 1, 2022, UnitedHealthcare ("United") released an update to its medical coverage policy (number 2022T0567V) and added language to indicate spinal cord stimulation (SCS) devices are not covered for treating chronic intractable back pain without prior spine surgery (NSBP). This policy becomes effective on December 1, 2022.  All other elements of their SCS coverage policy remained as they were before, including their recent decision to cover the use of SCS for Painful Diabetic Neuropathy (PDN).

Prior to this change, United had no coverage policy regarding NSBP patients. The company will continue to utilize the outcomes of its SENZA-NSRBP randomized controlled trial for chronic intractable back pain patients without prior spine surgery to support the patient prior authorization and appeals process.

The company does not expect this coverage decision to have a material impact on its go-forward revenue, and currently estimates the potential impact on 2023 revenues could be no more than the low to mid-single digit millions of dollars.

"Although this update is disappointing, there were United NSBP cases getting approved (and denied) before this change, and that will continue to be the case moving forward on an individual patient basis depending on a patient's unique clinical history and medical necessity," stated D. Keith Grossman, Chairman, CEO and President of Nevro. "As part of our ongoing reimbursement and access initiatives, we will continue to urge United, as well as other payers, to appropriately consider compelling, Level 1 clinical evidence, such as the NSBP data we and our investigators have produced. We view these decisions as a very normal part of the market access pathway for new products and patient indications, and believe our continued generation of high-quality clinical evidence will ultimately carry the day, just as it has thus far with the PDN indication."

The company expects to present its two-year follow-up data for the SENZA-NSRBP randomized controlled trial at the NANS 2023 meeting in January 2023 with a publication of the data to follow.

https://finance.yahoo.com/news/nevro-comments-unitedhealthcare-medical-coverage-110000848.html