United Healthcare approves reimbursement for MS PoNS device
United is second major healthcare provider to cover device, after Anthem
United Healthcare will reimburse the cost of the PoNS device, which uses electrical stimulation to improve walking, for its insured members with multiple sclerosis (MS).
The reimbursement covers $18,100 for the device and its controller, including patient copayment. This represents the device’s approximate list price adjusted for out-of-network status, according to its developer, Helius Medical Technologies. United is the second major healthcare provider to cover PoNS, follows an agreement with Anthem.
“This additional claim approval and reimbursement from a second major healthcare provider at typical out-of-network adjusted price further validates the clinical need and benefits of PoNS and reinforces the true value of the device,” Dave Andreeff, president and CEO of Helius, said in a company press release. “We believe this pricing should support further constructive conversations with payors.”
MS is a neurodegenerative condition caused by the immune system attacking the myelin sheath that protects nerve fibers. The damage that results disrupts nerve communication, leading to symptoms such as impaired movement and balance.
Recovering lost function in MS may depend on neuroplasticity, that is, the brain’s natural ability to reorganize and form new neural pathways in response to new experiences. While physical therapy can promote neuroplasticity, it may not be sufficient to improve movement as the disease progresses.
What are the benefits of using PoNS in MS?
PoNS is designed to enhance this process by delivering mild electrical impulses to the tongue via a mouthpiece. These impulses travel along two cranial nerves to the brain, stimulating regions involved in movement. This activation is thought to help the brain form new pathways that help compensate for lost function. The device is intended as a short-term treatment to improve gait in adults, ages 22 and older, with mild to moderate MS symptoms. It’s approved in the U.S. for use alongside physical therapy and is available by prescription.
PoNS has shown significant benefits in walking function and balance in people with MS who participated in clinical trials, and similar benefits have been observed in real-world studies. One, called PoNSTEP clinical trial (NCT05437276), examined the benefits of a 14-week PoNS therapy regimen — two weeks of in-clinic PoNS treatment supervised by a certified physical therapist followed by 12 weeks of unsupervised therapy at home — along with physical rehabilitation. This was similar to the design used in clinical trials that supported the device’s approval.
PoNS significantly improved walking function and the benefits were sustained over the long term, results showed. Those who adhered better to the treatment protocol in the unsupervised period saw the greatest gains.
In addition to people with private insurance, veterans and patients in other federal healthcare systems will be able to receive reimbursement for the device after a collaboration with Lovell Government Services. Medicare and Medicaid will provide partial reimbursement for the mouthpiece and controller, although Helius maintains the covered amount isn’t enough to make the therapy broadly accessible. The company hopes to partner with additional insurance providers to expand its availability.
“We continue to pursue commercial payor coverage and broad third-party reimbursement as part of our growth strategy to increase patient access to PoNS,” Andreeff said. “We are pleased with this progress in our efforts to support more MS patients.”
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