*The number of insurance carriers covering cross-linking and the number of covered lives listed here have been updated as of September 25th 2018. To view the current list of insurance plans with positive coverage policies, go to the Insurance Information page.
Cigna Is Newest Payer to Join Growing List of Commercial Plans Covering Avedro’s FDA-Approved Cross-Linking Procedure – 133 Million Lives Covered in Total
Avedro, Inc., an ophthalmic pharmaceutical and medical device company and world leader in corneal remodeling, today announced that 50 commercial insurance plans now cover Avedro’s FDA-approved corneal cross-linking procedure, following Cigna’s recent announcement that it is covering the Photrexa® drug formulations – Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution) – and the KXL® System used in the treatment of progressive keratoconus. Other health plans recently initiating coverage include Humana, Blue Cross Blue Shield of Florida, Capital Blue Cross of Central Pennsylvania, Health Alliance Plan of Michigan, Blue Cross Blue Shield of Minnesota, Blue Cross Blue Shield of North Dakota and Priority Health of Michigan.
These recent positive decisions added nearly 35 million beneficiaries across all 50 states bringing the total number of covered lives to 133 million. The updated list of plans with positive coverage policies for cross-linking can be found on the Insurance Information page. To identify a cornea specialist near you who is performing the FDA-approved procedure, you can search on the locator tool.
“In the past year, market access to FDA-approved corneal cross-linking has increased substantially. We have enjoyed collaborating with the ophthalmology societies and Avedro on this effort,” said Mary Prudden, Director of the National Keratoconus Foundation. “This encouraging progress will tremendously help patients who are struggling with progressive keratoconus, a sight-threatening disease.”
In a continued effort to expand market access and reimbursement for cross-linking, Avedro also announced that Tim Homer joined the company as Vice President of Health Policy & Market Access. Mr. Homer will lead Avedro’s health policy, reimbursement and government relations activities.
“Tim brings critical expertise to Avedro at an exciting time in our company’s history,” said Reza Zadno, PhD, CEO of Avedro. “We are particularly pleased with the momentum we are seeing among commercial payers and CMS’ preliminary decision to grant a product-specific J code for our Photrexa drug formulations. Working closely with our executive leadership team, Tim will lead our efforts to broadly communicate the value of corneal cross-linking.”
Mr. Homer’s first initiative has been to expand ARCH (Avedro’s Reimbursement Customer Hub) services, including establishing a new field-based team to educate physician offices and payers and ultimately expand patient access to cross-linking.
Mr. Homer has more than 20 years of medical device and health policy experience. Previously, Mr. Homer worked at IRhythm as Vice President of Health Policy and Market Access where he was instrumental in helping grow revenue to more than $100M. Prior to IRhythm, Mr. Homer led global reimbursement and market access activities at HeartWare and additionally, worked in similar capacities at Boston Scientific and Johnson & Johnson.