Cambridge Heart loses coverage decision at WellPoint

April 24, 2009 by MassDevice staff

Tewksbury cardiac diagnostics maker continues to struggle with reimbursement coverage from major Blue Cross affiliates.

One of the largest private insurers in the world will no longer cover a test that Cambridge Heart Inc. says can predict the risk of a sudden heart attack.

Indianapolis-based WellPoint changed its stance on the Tewksbury-based diagnostics firm's Microvolt T-Wave Alternans test, moving it from a covered to a non-covered service. WellPoint cited results from recent clinical trials as one reason for its decision.

The company is an independent licensee of the Blue Cross/Blue Shield health insurance system across the country. More than 35 million people get their health insurance through a WellPoint affiliate, according to the company's website.

The insurance giant's previous coverage included use of the test for patients who were candidates for implantable cardioverter defibrillators.

Cambridge Heart, which likens the MTWA test to a simple treadmill stress test, has been dogged by reimbursement woes. The company has had difficulty getting the MTWA test covered by some of the largest private health insurers in the world, including United Health and several Blue Cross/Blue Shield affiliates, according to its most recent quarterly report.

Company officials expressed disappointment at the news of another reimbursement setback, estimating that WellPoint's decision would affect about 16 percent of patients covered by private insurers.

However, "given the narrow scope of the original policy, this revision is expected to impact less than 2 percent of the estimated 6,000,000 high-risk cardiac patients currently covered for MTWA testing by either Medicare or other commercial health plans in the United States," they said.

The disappointing news comes on the heels of a bad year for the company. Cambridge Heart reported that sales dropped a whopping 58 percent in 2008, to $4.2 million, which the company blamed on troubles with a marketing deal with medical device giant St. Jude Medical and an overhaul of the company's sales pipelines. The soft revenues pushed net losses to $10.3 million for the year, compared to $9.9 million during 2007.