Hysterectomy Device Will Be Covered by Insurer Despite Danger of Uterine Cancer’s Spread

Written by Jeff Meyer on 29 Jun 2015

The fourth-largest health insurer in the country, Health Care Service Corp., will continue covering laparoscopic power morcellators. This, despite the fact that they were previously considering a policy that would have curtailed the use of these surgical tools which have come under greater and greater amounts of fire in recent years.

Last Year’s Warning

That doesn’t mean this story is over though. Health Care Service Corp. is just one of many insurers that have taken closer looks at these machines since the U.S. Food and Drug Administration issued a warning about them last year. While the FDA didn’t actually ban the tools or otherwise address how they could be sold, their warning to surgeons sent a shockwave through the medical industry.

The FDA also had plans to add a black box to all morcellators with a warning to surgeons reminding them of the dangers involved with using them. While that hasn’t happened, the largest manufacturer of the machines in the world, Johnson & Johnson, has taken it upon themselves to simply stop making them.

Last month, it was the third-largest insurer, Aetna Inc. that decided to review its policy on power morcellators. Their conclusion was to quit coverage where those machines were involved altogether. That was after they put tighter controls into place regarding their hysterectomy coverage. Instead, they will be pointing their customers toward procedures where these tools aren’t involved.

HCSC apparently considered adding a label to morcellation equipment that would read, “not medically necessary.” Had this policy gone into effect, it would have begun at the beginning of this month.

Instead, the insurer decided against the policy after gathering further opinions on the matter, according to a spokeswoman. Their plan is going to encourage dialog between the patient and provider. They have over 15 million members through Blue Cross and Blue Shield in states like Illinois, Oklahoma, New Mexico, Montana and Texas.

The Risks Involved with Power Morcellators

Power morcellators are tools used by surgeons during operations involving the uterus. They are designed to help remove body tissue, specifically tumors. Instead of the surgeon cutting into the woman enough that they’d have the room to handle the procedure with a scalpel or other tool, the morcellator is thin enough that a much smaller incision will do. The doctor holds and controls the tool at one end. At the other, there is a head of spinning blades that cuts away at the tissue and is meant to then help extract it.

Unfortunately, it’s been discovered that in many cases, the morcellator’s spinning action actually serves to send pieces of cancerous debris throughout the body. This, in turn, can end up unintentionally spreading cancer during a procedure meant to alleviate the threat.

According to the FDA’s estimates, one in every 350 women who are prescribed surgery for benign growths known as fibroids really have a type of soft-tissue cancer called sarcomas. This number came as a surprise to many doctors, but also helped punctuate the agency’s point: this tool is putting a lot of women at risk unnecessarily.

It’s worth noting that HCSC’s decision on the matter referenced that of the American College of Obstetricians and Gynecologists, the main gynecology association in the country. Their opinion was that doctors need to be upfront with patients about the potential risks and benefits associated with power morcellators, as well as alternatives to the tool.

Though some heavy hitters have weighed in, it’s clear this story isn’t over yet. In the meantime, if you or someone you know is prescribed uterine surgery, make sure there’s a conversation with the doctor about whether or not a morcellator will be used.

Source:

http://www.wsj.com/articles/hysterectomy-device-will-be-covered-by-insurer-despite-danger-of-uterine-cancers-spread-1433891661

Posted Under: Blog