Avedro announced that Anthem, the largest member of the Blue Cross Blue Shield Association, has issued a positive coverage policy for Avedro’s FDA-approved corneal cross-linking procedure bringing the total number of commercial plans covering the Photrexa drug formulations and the KXL System to 60. The addition of the nation’s second largest commercial plan affects 31 million beneficiaries, or 10 percent of the United States population.
Avedro has now secured positive coverage from America’s largest national commercial payers, United Healthcare, Anthem Blue Cross Blue Shield, Aetna, Cigna, Humana and HealthNet, facilitating access to more than 90 percent of commercially covered lives.
This news follows the recent decision by the Centers for Medicare and Medicaid Services (CMS) to issue a product-specific J code for Photrexa Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa (riboflavin 5’-phosphate ophthalmic solution). The new J code, J2787, will become effective on January 1, 2019.
“Over the past year and in collaboration with the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the Cornea Society, doctors and the National Keratoconus Foundation, we have made great strides in increasing market access to medically necessary, FDA-approved corneal cross-linking,” Reza Zadno, PhD, Chief Executive Officer of Avedro, said in a company news release. “In the past month alone, our Photrexa drug formulations were issued a permanent J code from CMS, and we added an additional 40 million lives who can access cross-linking. Our goal is to ensure cross-linking is accessible to every patient struggling with progressive keratoconus. Reaching these milestones brings us increasingly closer to this goal.”
“This news is certainly encouraging to patients who are struggling with this sight-threatening disease, and it is wonderful to see that our combined efforts are having a significant impact on market access,” Mary Prudden, Director of the National Keratoconus Foundation, said in the news release. “Increasingly, we are hearing from patients that they are now able to obtain coverage for their treatment. I am very hopeful that this trend will continue.”
Patients can find the list of private payer insurance companies providing coverage for corneal cross-linking at LivingwithKeratoconus.com.