Health insurer Aetna has agreed to cover Abbott’s Proclaim neurostimulation pain therapy under a new national policy.
The decision means Aetna’s 22 million medical plan members can access an implant that alleviates pain by stopping signals passing from the dorsal root ganglion (DRG) to the brain.
Increasing access to the device may further efforts to counter the opioid epidemic through the provision of alternative painkillers, while also helping Abbott generate a return on its $25 billion takeover of St. Jude Medical.
Opioids such as oxycodone, morphine, hydrocodone and fentanyl can effectively alleviate pain caused by complex regional pain syndrome (CRPS) and other conditions. Amid claims the drugs were non-addictive, use of the drugs soared in the 2000s, which has created ongoing problems for the country. In 2015, one-third of U.S. adults used prescription pain relievers, according to government data. More than 10% of these adults misused the painkillers at least once in 2015.
The prevalence of painkiller use and misuse has created an epidemic. By 2016, 2.1 million people in the U.S. had an opioid-use disorder. The same year, more than 17,000 people died after overdosing on prescription opioids.
Those numbers have spurred businesses and U.S. regulatory agencies to prioritize the development and availability of non-opioid painkillers that help people manage their conditions without exposing them to the risks of misuse. Abbott sees its Proclaim implant, which it acquired in the takeover of St. Jude, as such a non-opioid painkiller.
The FDA approved the device in 2016. Medicare soon decided to cover the implant but private payers have been slower to act. Getting coverage from Aetna marks an important step in Abbott’s efforts to convince payers of the safety and efficacy of Proclaim.
Abbott’s case for Proclaim is underpinned by data from a trial of 152 people with CRPS or causalgia. After three months, 81% of patients who received Proclaim experienced a 50% or greater reduction in pain. Around 55% of patients who received spinal cord stimulation, the control treatment, experienced that level of pain relief, resulting in the clinical trial meeting its primary endpoint.
In persuading Aetna to cover Proclaim, Abbott has opened up a sizable new market, furthering its efforts to counter the opioid epidemic and generate a return on its acquisition of St. Jude.