Entellus Medical (ENTL) Reports Positive Coverage Decision for Balloon Sinus Dilation by Anthem Inc. (ANTM)
Entellus Medical, Inc. (NASDAQ: ENTL) today announced that Anthem, Inc. (NYSE: ANTM) now covers balloon sinus dilation (BSD) for the treatment of chronic and recurrent acute sinusitis. Anthem, the largest member of the Blue Cross Blue Shield Association, is the nation’s second largest health benefits company with plans that cover over 40 million lives, or 12.5% of the population of the United States.
This new policy extends coverage to patients with both chronic and recurrent acute sinusitis. This includes patients with documented evidence of sinus disease upon physician examination, via nasal endoscopy, or on a computer tomographic (CT) scan. The overall criteria for coverage closely aligns with the recently developed clinical consensus statement soon to be published by the American Academy of Otolaryngology – Head and Neck Surgeons (AAO-HNS) on balloon dilation of sinuses.
“The recent positive coverage decision by Anthem brings total covered lives for BSD in the United States to over 290 million, enabling broad availability of cost effective solutions for the treatment of chronic sinusitis with our XprESS system,” said Robert White, President and Chief Executive Officer of Entellus Medical. “We have considerable momentum driven by our broad portfolio and pipeline, clinical programs, and expanded reimbursement to improve patients’ lives.”
With the Anthem policy change, approximately 95% of insured patients in the United States now have access to balloon dilation of the sinuses as covered treatment option when appropriate. This policy change further underscores clinician and payer confidence in the safety and efficacy of BSD as established by a significant body of clinical evidence, and in the value of this technology intended to enable better patient outcomes in more cost-effective sites of care.