Insurers Move to Minimize Morcellator Use

Written by Jeff Meyer on 10 May 2015

There was a time when the only relationship insurance companies had with morcellators was simply paying out when one of their customers need a hysterectomy, myomectomy or some similar procedure. A lot has changed since then, though, represented by the fact that more and more insurance companies are now rallying to see the morcellator’s use discontinued. This past April saw even more join the battle on the insurance’s side of things. They are accompanied by the FDA and even Johnson & Johnson, the company that was formerly the number one manufacturer of this equipment in the entire world.

In 2014 the FDA started making announcements regarding its use. After over 20 years of use, spokesmen at the FDA began claiming that this trusted tool was actually responsible for countless women being diagnosed with cancer.

When the morcellator works correctly, it’s the ideal tool for a hysterectomy and procedures similar to it. These surgeries need a tool that can slip into the body through a slender incision and tear through fiber and tissue no longer needed. Once the morcellator is removed, a tiny vacuum is used to pull the shredded debris.

When the morcellator works incorrectly, it can spread cancer throughout the patient’s body. The FDA estimates that roughly one out of every 350 who go in for a hysterectomy or myomectomy and have a morcellator used also have a cancerous growth present. If the morcellator comes in contact with it, the device cuts it up into tiny pieces and then spreads it out. This is how these tiny cells grow into cancerous tumors later on.

Johnson & Johnson Joins the Fight

Originally, the giant corporation wanted little to do with this fight and was even vocal about it, telling the press that they would wait to see what came of further inquiries. True to their word, though, when the FDA provided more evidence, Johnson & Johnson was swift in pulling their products. Aside from the fact that they had a new design on its way, and the company was also the largest manufacturer of morcellators on the planet.

Insurance Companies Line Up Against Morcellators

Now, even insurance companies are coming forward to denounce the use of these devices. Together, those that have spoken up, represent some 92 million Americans. One of them, Health Care Service Corp. (which happens to be the fourth largest health insurer in the country) has proposed labeling the devices with the words, “not medically necessary.”

While this may sound like little more than a benign warning, it’d actually pull a lot of weight. This kind of label would mean surgery with the device would typically not be eligible for coverage. That alone would almost completely ensure the morcellator never gets used again.

A spokeswoman for Aetna Inc. made it clear they are looking into similar options. As the third largest insurer in the U.S., they have approximately 23 million customers. By changing their coverage of morcellators, Aetna Inc. could also have a huge impact on their use.

Lastly, UnitedHealth Group Inc. has already decided to change the way it covers surgery using these tools. In the majority of cases, a surgeon must first check with them and obtain authorization before moving forward with using a morcellator.

There are still plenty of other insurers out there, but UnitedHealth, the largest, adds another 40 million to the list of customers who probably won’t be eligible for surgeries that use morcellators. At this rate, it’s all but certain that this device will almost never get used again.

Source:

http://www.wsj.com/articles/more-health-insurers-take-action-to-limit-morcellator-use-1428009386

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