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Non-Invasive Neuromodulation of the Central Nervous System Opportunities and Challenges: Workshop Summary (2015) / Chapter Skim
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9 Reimbursement Issues
Pages 65-70

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From page 65...
... • Health plans individually determine whether treatment will be reim bursed based on multiple types of research data -- RTC, population based, comparative effective (often imcomplete or conflicting in this area) , comparative efficiencies and cost considerations, and the exist ence of practice guidelines.
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From page 66...
... Different health plans reached different conclusions: One decided to cover TMS after the fourth failed antidepressant trial; another stipulated that TMS would be covered only in patients who had adverse effects from antidepressant therapy, or who could not tolerate antidepressant treatment, or who preferred TMS as an alternative to ECT. Coverage decisions also differ by
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From page 67...
... Indeed, Eric Liebler, vice president of scientific, medical, and governmental affairs at electroCore, suggested that cost may have a positive impact on reimbursement for neurostimulatory devices because the costs of these devices may be materially less than some of the new pharmaceutical therapies coming out today. Practice guidelines are another important factor in coverage decisions, said Robinson-Beale, but the American Psychiatric Association has provided very little detail regarding TMS other than to mention it as a possible treatment for depression, without identifying a clear target population.
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From page 68...
... She said payers would prefer to see comparative effectiveness of a treatment against the standard of care rather than sham treatments, as well as objective efficacy analysis that includes cost as a factor. If researchers and other data sources were able to answer key questions that are important to that application of a technology in real life practice, health plans would have more opportunity to make clear decisions on medical policy, and less of an opportunity to reject coverage reimbursement, she said.
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From page 69...
... For example, Thomas Insel asked if there is a separate standard for medicine versus behavioral health, citing the insulin pump, a much more expensive device that has received positive reimbursement decisions from CMS and most insurers. Robinson-Beale attributed this disparity to the fact that medical devices enjoy a longer history of acceptance, whereas behavioral devices are relatively new, requiring a new way of thinking on the part of those making decisions.
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Key Terms

  • reimbursement decisions
  • comparative effectiveness
  • standard treatment
  • patient access
  • american psychiatric

  • psychiatric association
  • tms service
  • positive reimbursement
  • affect reimbursement
  • health plan

  • associated health
  • inconsistent reimbursement
  • reimbursement policies
  • determining reimbursement
  • behavioral health

  • coverage reimbursement
  • lack access
  • include consensus
  • managing director
  • reimbursement landscape

  • treatment effectiveness
  • pharmaceutical therapies
  • service averaged
  • treatment sessions
  • cost versus

  • clarity regarding
  • inconsistent care
  • devices compared
  • marketing approval
  • individual speakers


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