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Daily Briefing

Around the nation: Medicare may reimburse for virtual reality therapy


A recent  CMS  ruling signals that Medicare may reimburse clinicians for using virtual reality technologies, in today's bite-sized hospital and health industry news from Illinois, Maryland, and Minnesota.

 

  • Illinois: Walgreens and  Prothena last month entered a partnership to drive increased patient identification and recruitment for Prothena's ongoing ASCENT-2 clinical trial evaluating the safety and tolerability of PRX012 — an anti-amyloid beta antibody being developed to treat Alzheimer's disease. Under the partnership, Walgreens will tap its national footprint, portfolio of industry-leading healthcare companies, and compliance framework to match patient populations to the PRX012 trial, which has been fast tracked by  FDA. "Alzheimer's disease is an incredibly complex disorder and requires all stakeholders to work together to develop and evaluate effective therapies," said Ramita Tandon, Walgreens' chief clinical trials officer. "Through Walgreens trusted community pharmacy presence and daily interactions with millions of patients across America, we believe we can have a meaningful impact in helping Prothena with their clinical trial recruitment efforts. Our aim is to help build a more representative patient population for Alzheimer's research, particularly among underserved and diverse communities, to create a better understanding of this disease." (Mesa, BioSpace, 5/1; Walgreens news release, 4/13)
  • Maryland: A recent CMS ruling signals that Medicare may reimburse clinicians for using virtual reality technologies for care. Last month, CMS ruled that  AppliedVR's  RelieVRx therapy for back pain would fall under a new durable medical equipment designation, marking the first time the designation had been made for a virtual reality-based therapy. "We're putting everything, all the pieces in place, so that you can get that broad scalability and adoption in the market," said Matthew Stoudt, CEO and co-founder of AppliedVR. "In our case, as a therapeutic, it comes down to reimbursement." In the ruling, CMS said they made the designation because the software and device were "so integral" and other non-medical software could not be added to the device. According to CMS' report, the virtual reality headset cannot be replaced with another consumer model or personal computer. While the agency approved the therapy, it has not yet set a specific reimbursement structure for what the company will be paid. According to Stoudt, setting a reimbursement pathway through CMS played a "critical" role in the company's long-term success. (Turner, Modern Healthcare, 5/1)
  • Minnesota: Bright Health on Friday announced that it is selling its health insurance operation amid negotiations with lenders to avoid bankruptcy. To qualify for a credit extension through June, the company must find a buyer for its California Medicare Advantage business by the end of this month, according to a filing to the  Securities and Exchange Commission. Under the terms of the amended credit agreement, Bright Health would have to maintain $50 million in cash — a decrease from $85 million under the current agreement. Moving forward, Bright Health will focus solely on its primary care business, NeueHealth, which includes 74 clinics in Florida and Texas that serve 375,000 patients. (Tepper, Modern Healthcare, 4/28)

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