October 9, 2024
Manisha Dhuria, MD, MBA, CPE
Associate VP, Physician Leadership, Humana
mdhuria@humana.com
Dear Dr. Dhuria,
We are writing on behalf of the more than 95,000 members our undersigned societies represent. Our members include anesthesiologists, neurologists, neurosurgeons, orthopedic surgeons, physiatrists, psychologists, radiologists, engineers, scientists, and health care professionals. We are all dedicated to improving the care patients receive when dealing with chronic neurologic disorders, including severe debilitating pain.
Now that your Humana Medicare Advantage plan removed closed-loop spinal cord stimulation therapy as “experimental, investigational, and/or unproven,” we write to you in hopes that your commercial plan will follow suit. We express our profound objection to the current characterization
by your commercial coverage policy of closed-loop spinal cord stimulation therapy as experimental, as it is our firm belief that such a classification does a disservice to patients and neglects the scientific research, rigorous clinical trials, and evidence supporting the efficacy of closed-loop SCS therapy.
Closed-loop technology is an evolutionary approach to SCS compared to the traditional open-loop technology. As opposed to a standard neurostimulator, a closed-loop device actively monitors the spinal cord responses to the delivered electrical stimulation. The device then rapidly and automatically adjusts the strength of stimulation in response to the evoked activity in the spinal cord based on patient-specific values for comfort and pain relief. This represents a significant evolution in SCS technology. Closed-loop SCS has been studied in high-level peer-reviewed
publications, including randomized, blinded clinical trials. The outcomes of these trials demonstrated substantial improvements in pain in patients suffering from back and leg pain with three-year follow up (Evoke study). Furthermore, closed-loop SCS has enabled a considerable
number of patients in both the Evoke and Avalon studies to successfully taper off opioid therapy, underscoring its effectiveness and impact on public health. It is also important to note the holistic responses to closed-loop therapy that are observed in these studies. Specifically, drastic
improvements in sleep, function (as measured by Oswestry Disability Index), mood and quality of life. As such, the secondary benefits of closed-loop spinal cord stimulation will likely have profound impacts on multiple aspects of our patients’ lives and not only subjective pain relief.
Read full letter here.
