The Bloomfield, Conn.-based health insurer only reimbursed for 3D breast scans made for diagnosis, based on the U.S. Preventive Services Task Force’s finding that there’s not enough data to show that 3D mammography is better than traditional mammography in screening for breast cancer.
The decision to expand reimbursement for the 3D scans, which took effect yesterday, was based on new input from the National Comprehensive Cancer Network, Cigna said.
“We are always open to change based on new scientific evidence or new guidance from respected non-commercial organizations like the NCCN,” senior medical director Dr. Julie Kessel said in prepared remarks. “We have a responsibility to our customers and clients to ensure that the medical treatments, tests and procedures they’re paying for have proven clinical value and will help improve their health and well-being. That’s a responsibility that we don’t take lightly.”
GE Healthcare (NYSE:GE) and Hologic (NSDQ:HOLX) are the only companies with mammography systems than can perform 3D breast tomosynthesis on the U.S. market. GE Healthcare won FDA approval for its SenoClaire 3D platform in September 2014.
A month later, the Centers for Medicare & Medicaid Services established new reimbursement codes for the 3D breast scans, which was a boon for the SenoClaire system and for Hologic’s Selenia Dimensions system. That device won FDA approval in February 2011.
Hologic said yesterday that Cigna’s decision to expand its coverage makes it the 1st national insurer to reimburse for routine annual scans.
“We commend Cigna for its decision to cover 3D mammograms for breast cancer screening and are thrilled for the millions of women who now have access to this proven technology without co-pays or out-of-pocket expenses,” breast & skeletal health president Pete Valenti said in prepared remarks.