Highmark Inc, one of the largest Blue Cross Blue Shield insurers in the United States, has announced that as of September 1, 2014, it will no longer cover laparoscopic power morcellation. This decision affects approximately 5.2 million customers in Pennsylvania, West Virginia, and Delaware as well as their health care providers.
Highmark is the first insurer to stop coverage of this now-controversial procedure, which uses a bladed tool to divide larger tissue for removal through a laparoscopic port. For patients with large uterine fibroids, the advantage of power morcellation is that it allows for minimally invasive surgery, making the recovery period easier and shorter than it would be in traditional open abdominal surgery. The disadvantage is that if the fibroid or mass is masking a cancerous tumor, than the cancer can spread throughout the abdomen.
After studying the issue, Highmark has determined that the procedure's risk-benefit profile is underwhelming and that it is in the best interest of its members to no longer cover this procedure. This decision follows an FDA safety communication that discouraged the use of power morcellation and Johnson&Johnson's decision to suspend sales of its power morcellators.
According to a report in the Wall Street Journal, Allegheny Health Network, a multihospital health system that Highmark owns, has stopped offering the procedure as well. Unrelated to Highmark's decision, the University of Pittsburgh Medical Center also will no longer be offering power morcellation.
We want to hear what you think and welcome your thoughts in the Comment section below:
Do you think other insurers will follow this decision? How does this affect your practice?