Inspire Medical Systems scores win with Blue Cross Blue Shield Association

Inspire Medical Systems – creator of a pacemaker-like system to treat obstructive sleep apnea – said today that the Blue Cross Blue Shield Association’s Evidence Street issued a positive assessment of Inspire therapy to its members.

BCBSA is a national federation of 36 Blue Cross and Blue Shield companies.

The report from BCBSA, according to Inspire (Maple Grove, Minn.), found sufficient evidence that an Inspire-type therapy provided meaningful improvement in the net health outcome for sleep apnea patients falling under certain criteria: over 22 years old (as well as 10- to 21-year-olds with Down’s syndrome), moderate to severe obstructive sleep apnea, CPAP failure or inability to tolerate CPAP, body mass index equal or less than ≤ 35 kg/m2 in adults, and a favorable pattern of palatal collapse.

“This positive assessment demonstrates the strength of the clinical evidence for Inspire therapy and is an important step forward in securing coverage from health insurance providers in the BCBS affiliate network,” Inspire Medical Systems CEO Tim Herbert said in a news release.

“This positive Evidence Street assessment for Inspire therapy will provide us with key support in our ongoing discussions with BCBS companies that relate to positive coverage decisions in the future,” Herbert said. “The positive review further validates the benefits of Inspire therapy, and we continue to believe that our growing body of clinical and real-world data will be the basis for additional coverage decisions by other major health plans, as well as provide support to centers in obtaining individual prior authorization approvals.”

The Blue Cross and Blue Shield Association launched Evidence Street in 2016 as a web-based platform to provide healthcare decision-makers easy access to impartial medical evidence reviews for devices, diagnostics and pharmaceuticals.

Achieving reimbursement has been an important goal for Inspire Medical Systems. These days, it’s about scientifically valid, real-world data including randomized controlled trials — and lots of persistence, Kathy Sherwood, Inspire’s VP of global market access, explained during a panel at the University of Minnesota last year.