Nevro Wins Multiple Coverage Options For Spinal Cord Stimulation In Diabetic Neuropathy

Nevro Corp NVRO announced positive updates to multiple spinal cord stimulation (SCS) coverage policies.
Aetna’s new SCS policy explicitly covers PDN (painful diabetic neuropathy), effective August 29, 2022. Aetna’s health plan covers approximately 22 million commercial lives.
Novitas and First Coast also provided a positive update. They published draft local coverage determinations (LCDs) that proposed updated coverage criteria to include PDN.
This includes PDN refractory to conventional medical management for SCS devices with explicit FDA approval to treat PDN.
If finalized, the LCDs mean Medicare patients in all 50 states will receive coverage for PDN, adding approximately 17 million covered Medicare lives. The review for the proposed LCDs is ongoing, with finalization dates yet to be determined.
Nevro said Aetna’s update adds to recent positive decisions from UnitedHealthcare, Blue Cross Blue Shield, and Noridian. Altogether, these decisions increase coverage in the U.S. to approximately 54% of PDN patients. That represents a rise from approximately 25% at the end of 2021. If the MAC policies pan out, coverage rises to approximately 66%.
Price Action: NVRO shares are down 3.50% at $43.74 on the last check Thursday.