Santa Clara, California-based SI-BONE, Inc. recently announced the decision from the U.S.’ fifth largest commercial insurer, Humana, Inc. to exclusively cover SI-BONE’s iFuse triangular implant for sacroiliac (SI) joint fusion (SIJF).
The change was published in Humana’s coverage guidelines dated December 10, 2020. This change will allow SI-BONE to gain a larger market share of this procedure, which is growing in popularity as physicians recognize the importance of the SI joint as a pain generator. Additionally, Centers for Medicare and Medicaid Services (CMS) increased the physician reimbursement rate for the procedure by over 25% as of January 1, 2020, further driving interest in the procedure.
The iFuse system from SI-BONE consists of triangular 3D-printed titanium rods, much like an unsegmented Toblerone chocolate bar. The cannulated implant can be inserted over K-wire to assist in accurate insertion, and allows for boney growth throughout the implant. The triangular shape provides greater resistance to rotation than cylindrical cages or screws, though 2-3 iFuse implants per side are recommended for proper fixation and fusion.
President, CEO, and Chairman of SI-BONE Jeffrey Dunn was enthusiastic about the announcement. “We are thrilled with Humana’s decision to cover MIS SI joint fusion procedures that use iFuse for its members, and with clinical criteria that aligns closely with guidelines from professional spine societies like NASS [North American Spine Society] and ISASS [International Society for the Advancement of Spine Surgery],” he said. “With this updated policy, Humana joins 36 other health plans that cover MIS SI joint fusion using the iFuse Implant System exclusively, as well as other large payors including UnitedHealthcare, CIGNA and Aetna, which also provide positive coverage for iFuse procedures,” Dunn continued in the press release from the company.
A quick search of the literature of SIJF reveals the lopsided nature of publications covering the procedure. SI-BONE’s iFuse (often referred to as a “triangular implant”) accounts for a disproportionate number of articles researching SIJF. Additionally, many of the other implants on the market list iFuse as the predicate device for gaining FDA clearance. SI-BONE is now reaping the rewards of its investment in early research of its technology.
