Medical Mutual of Ohio updated its coverage to include the Spiration Valve System for eligible patients suffering from severe emphysema, a form of chronic obstructive pulmonary disease (COPD). This coverage provides a minimally invasive treatment alternative for eligible patients.
This follows similar coverage decisions by Highmark and Health Care Service Corporation (HCSC), leading licensees of Blue Cross and Blue Shield Association. Aetna and Humana also cover the Spiration Valve System under applicable policies.
“This decision by Medical Mutual will provide expanded access to this critical therapy that significantly reduces lung hyperinflation associated with severe emphysema, and is durable over time,” said Jason Stienecker, MD, division chief for Pulmonary at Lima Memorial Health System in Lima, Ohio. “Spiration Valve treatment can lead to truly meaningful improvements in patients who achieve sustainable clinical outcomes such as improvements in lung function and quality of life.”
Spiration Valve System
During the minimally invasive BLVR procedure with the Spiration Valve, umbrella-shaped endobronchial valves are positioned in selected airways. The valves allow air to flow in only one direction, preventing air from flowing into the diseased part of the lung and redirecting air to healthier lung tissue. The treatment relieves the hyperinflation of the diseased portions of the lungs and allows healthier parts of the lungs to expand and function more effectively. With improved breathing, patients suffer from less breathlessness and have improved lung function and, as a result, may be able to do more in their daily lives and enjoy an improved quality of life.
Patient selection is a first step in determining who qualifies for this treatment. A decade of clinical studies has shown that patient selection is one of the most important factors in predicting a positive response to BLVR. To determine if a patient is eligible for Spiration Valve treatment, physicians use a completely non-invasive patient screening tool called SeleCT and the patient’s computerized tomography (CT) scan. This selection method, using criteria validated in the EMPROVE trial, does not require more invasive patient selection methods.