Out of Network reimbursement is only the first step towards expanding third-party paid access to PoNS
Helius Medical Technologies, a neurotech company focused on delivering a novel therapeutic neuromodulation approach for balance and gait deficits, announced an authorized claim for payment for the PoNS Device from a third major healthcare provider, Aetna Healthcare.
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“The recent reimbursement approvals from two major commercial healthcare payers, with a third underway, mark significant milestones for Helius and the MS community,” said Dane Andreeff, Helius’ President and Chief Executive Officer. “We are actively pursuing broader in-network coverage for PoNS at list price from major commercial payers, while continuing to negotiate reimbursement on a case-by-case basis. We expect to continue our efforts in expanding patient access and ensuring consistent reimbursement as we work to align commercial payments with the rates currently offered by the VA/DoD at $26,228. At the same time, we remain firmly committed to supporting individuals with MS who rely on Medicare for PoNS treatment and believe this, along with other 3rd party payer reimbursement decisions will benefit our continued efforts to secure fair and adequate reimbursement by CMS for the PoNS system.”
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The out-of-network price, which typically is 30 to 40% below in-network contracted payment rates of $18,350, was negotiated and accepted by Aetna Healthcare to fulfill the prescription of the PoNS Device for an individual with multiple sclerosis. Depending on the individual’s deductible and out-of-pocket costs, this claim may not result in an immediate PoNS Device sale.
About the PoNS Device and PoNS Therapy
The Portable Neuromodulation Stimulator is an innovative, non-implantable, orally applied therapy that delivers neurostimulation through a mouthpiece connected to a controller and it’s used, primarily at home, with physical rehabilitation exercise, to improve balance and gait. The PoNS device, which delivers mild electrical impulses to the tongue, is indicated for use in the United States as a short-term treatment of gait deficit due to mild-to-moderate symptoms from MS and is to be used as an adjunct to a supervised therapeutic exercise program in patients 22 years of age and over by prescription only.
PoNS has shown effectiveness in treating gait or balance and a significant reduction in the risk of falling in stroke patients in Canada, where it received authorization for sale in three indications: (i) for use as a short-term treatment (14 weeks) of gait deficit due to mild and moderate symptoms from stroke and is to be used in conjunction with physical therapy; (ii) for use as a short-term treatment (14 weeks) of chronic balance deficit due to mild-to-moderate traumatic brain injury (“mmTBI”) and is to be used in conjunction with physical therapy; and (iii) for use as a short-term treatment (14 weeks) of gait deficit due to mild and moderate symptoms from MS and is to be used in conjunction with physical therapy.
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Source – GlobeNewswire
