SummaryNew Avalere research found that public and private payers reversed non-coverage policies following a recommendation from a regional CER initiative.
In 2011, the New England Comparative Effectiveness Review Public Advisory Council (CEPAC) voted that the evidence on repetitive transcranial magnetic stimulation (rTMS) was as good as or better than usual care for patients with treatment-resistant depression. CEPAC provided specific recommendations for payers on how to cover rTMS.
Avalere analyzed publicly available Medicare and private payer coverage policies before and after the CEPAC recommendation and found that public and private payers inside and outside of New England reversed their non-coverage policies following CEPAC’s recommendation. For example:
3 out of 8 local Medicare contractors
- that considered CEPAC recommendations reversed their non-coverage policies
1 out of the top 3 private payers
- (by enrollment) reversed its standing non-coverage decision and covered rTMS with conditions and cited the CEPAC recommendation
3 of 4 regional private payers in New England
- cited in CEPAC’s report as not covering rTMS for depression reversed their coverage policies to cover rTMS with conditions