CMS Proposes To Deny Medicare Coverage For Johnson & Johnson
Artificial Spinal Disk
21 Feb 2006
CMS has
proposed to deny Medicare coverage for Charite, an artificial spinal
disk manufactured by Johnson & Johnson, because of a lack of
evidence to indicate that the surgery to implant the device is
"reasonable and necessary," the Wall Street Journal
reports. CMS will hold a 30-day public comment period on the
proposal to deny Medicare coverage for Charite, which costs about
$11,500 and as much as $50,000 to implant, with a final decision
expected within the subsequent 60-day period. The proposal to deny
Medicare coverage for Charite could prompt private health insurers
to take similar actions. According to the Journal, such
actions would represent a "rare setback" for J&J, which has
"excelled at persuading insurers to pay for new technology." J&J
does not release sales information on Charite, but Merrill Lynch predicts that annual sales of the
device will decrease to $21 million this year from $41 million in
2005. "We are disappointed by the proposed recent CMS noncoverage
decision and are concerned that this action may limit access for
degenerative-disk disease patients who could benefit from this
technology," a spokesperson for DePuy Spine, the J&J division that markets
Charite, said (Hensley, Wall Street Journal, 2/17).
