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Great news.
Now that the 3 largest private health insurance carriers in the USA cover Optune, the rest should follow suit soon! This is a major victory in the fight against brain tumors. We thought the hard part was going to be getting FDA approval because it is a completely new type of treatment, but that actually was easy since the data supported it. Once that happened, I assumed patients would be able to just get it but the timing was terrible. Insurance companies have just started fighting back against expensive treatments and started denying all new treatments as a way of saving money until they are forced to pay for them. It was a long, hard battle but the people at Novocure persevered and won the battle with the private insurers.
Next up is Medicare. I had multiple meetings with Medicare and they are getting close to approving payment. The people I met with at Medicare understand that brain tumor patients need this treatment and they are trying to find a way to pay for it. Having the majority of private insurance companies paying for Optune, along with the recent publication of data in the Journal of the American Medical Association, should allow patients to appeal Medicare rejections successfully. IF you have a problem with a Medicare rejection, call me at 888-295-4740 and maybe I can write a letter for you to help with the appeal.
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12 February 2016 Anthem Inc. Issues Positive Coverage Decision For Optune in Newly Diagnosed Glioblastoma
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Health insurance plans covering more than 97 million Americans now provide positive coverage of Optune ST. HELIER, Jersey--(BUSINESS WIRE)-- Novocure (NASDAQ:NVCR) announced today that Anthem, Inc. now covers Optune for members who have newly diagnosed glioblastoma (GBM). Anthem, the largest member of the Blue Cross Blue Shield Association, is one of the nation’s leading health benefits companies with plans that cover 38.5 million lives. Anthem’s positive coverage policy of Optune – a portable, noninvasive device that delivers Tumor Treating Fields (TTFields) therapy to patients with newly diagnosed and recurrent GBM – follows the December 2015 publication of Novocure’s EF-14 phase 3 pivotal trial data in the Journal of the American Medical Association (JAMA) Anthem is the fourth and latest national commercial payer to issue a positive coverage policy for Optune. In December 2015, Aetna, Inc. released a medical coverage policy that affirmatively covers Optune for the treatment of newly diagnosed GBM. Aetna is one of the top three commercial payers in the U.S., covering 23.5 million lives. Cigna and HealthNet – administering medical benefits for 14.5 million and 6 million lives, respectively – offer coverage of Optune for members who have recurrent GBM. Additional commercial payers that offer positive coverage policies for Optune include: Excellus Blue Cross and Blue Shield, Medica, The Health Plan of the Upper Ohio Valley, and Priority Health, which in total administer health plans covering 3.7 million lives. Collectively, health plans covering more than 97 million Americans now provide positive coverage of Optune. “The recent positive coverage by Anthem and Aetna of Optune for newly diagnosed glioblastoma signals that leading healthcare payers view Optune as a medical necessity for newly diagnosed glioblastoma patients,” said Asaf Danziger, Novocure’s CEO. “We are working diligently to build awareness of our EF-14 trial results, now published in JAMA, which show that Optune plus standard of care significantly extended both progression-free and overall survival in newly diagnosed GBM patients. Optune offers hope of a longer, better quality life for patients who are diagnosed with this devastating disease.” About Tumor Treating Fields Therapy Tumor Treating Fields (TTFields) therapy is delivered by a portable, non-invasive medical device designed for continuous use by patients. In vitro and in vivo studies have shown that TTFields therapy slows and reverses tumor growth by inhibiting mitosis, the process by which cells divide and replicate. TTFields therapy creates low intensity, alternating electric fields within a tumor that exert physical forces on electrically charged cellular components, preventing the normal mitotic process and causing cancer cell death. Approved Indications In the United States, Optune is intended as a treatment for adult patients (22 years of age or older) with histologically-confirmed glioblastoma multiforme (GBM). In the United States, Optune with temozolomide is indicated for the treatment of adult patients with newly diagnosed, supratentorial glioblastoma following maximal debulking surgery and completion of radiation therapy together with concomitant standard of care chemotherapy. In the United States, for the treatment of recurrent GBM, Optune is indicated following histologically-or radiologically-confirmed recurrence in the supratentorial region of the brain after receiving chemotherapy. The device is intended to be used as a monotherapy, and is intended as an alternative to standard medical therapy for GBM after surgical and radiation options have been exhausted. In the European Union, Optune is intended for the treatment of patients with newly diagnosed GBM, after surgery and radiotherapy with adjuvant temozolomide, concomitant to maintenance temozolomide. The treatment is intended for adult patients, 18 years of age or older, and should be started more than four weeks after surgery and radiation therapy with adjuvant temozolomide. Treatment may be given together with maintenance temozolomide and after maintenance temozolomide is stopped. In the European Union, Optune is also intended for the treatment of patients with recurrent GBM who have progressed after surgery, radiotherapy and temozolomide treatment for their primary disease. The treatment is intended for adult patients, 18 years of age or older, and should be started more than 4 weeks after the latest surgery, radiation therapy or chemotherapy. Patients should only use Optune under the supervision of a physician properly trained in use of the device. Full prescribing information is available at www.optune.com/safety or by calling toll free 1-855-281-9301 in the US or by email at supportEMEA@novocure.com in the European Union. About Novocure Forward-Looking Statements Media and Investor Contact: |
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