Highmark is an independent licensee of the Blue Cross Blue Shield Association. It primarily covers Pennsylvania, New York, Delaware, and West Virginia and BCBS North Dakota.
The new policy decisions went into effect Jan. 30, 2023, for Highmark and March 6, 2023, for BCBS North Dakota. It outlines the criteria for medical necessity and expands potential treatment eligibility to patients indicated for VBT, ZimVie said. According to a news release, it applies to more than 4 million members covered under Highmark and 280,000 under BCBS North Dakota.
In particular, the policy decisions benefit the ZimVie Tether device. ZimVie designed Tether as a first-of-its-kind, non-fusion scoliosis treatment. The company said it marks the only FDA-approved device for VBT. More than 1,300 children have received Tether since the FDA granted humanitarian device exemption (HDE) in August 2019. Approximately 65 U.S. surgeons perform the procedure today, ZimVie noted.
“The Highmark and BCBS North Dakota coverage decisions validate the expectation we noted when we announced the Anthem BCBS positive coverage decision in July, that additional policy updates would follow. It is encouraging to see broader endorsement of this opportunity to positively impact the lives of children with scoliosis through a motion-preserving alternative to spinal fusion,” said Rebecca Whitney, SVP and president of global spine for ZimVie. “We are honored to work with orthopedic and neurosurgeons to develop vertebral body tethering solutions that may allow children with scoliosis to return to their active daily lives.”
Since its spinoff from Zimmer Biomet more than a year ago, ZimVie officials have seen pediatric scoliosis treatments as one of the areas where they can grow the company’s spine business.