Aetna agrees to reimburse PoNS device for MS patients
Company now third private insurer in US to approve reimbursement
Aetna Healthcare has agreed to reimburse Helius Medical Technologies’ PoNS device, short for Portable Neuromodulation Stimulator, which uses electrical stimulation to improve walking in people with multiple sclerosis (MS).
The policy covers PoNS at an out-of-network negotiated price of $18,350, making Aetna, one of the largest private health insurers in the U.S., the third major one to approve reimbursement for the device, after Anthem and United Healthcare.
The reimbursement means Aetna members may submit a claim for the treatment even if their clinician is not in Aetna’s network. Whether the claim results in an immediate sale depends on each patient’s deductible and out-of-pocket costs, however.
According to Helius, out-of-network reimbursement is the first step toward making PoNS more accessible to people with MS, but the company remains committed to continuing to expand access and securing in-network coverage at list price.
“The recent reimbursement approvals from two major commercial healthcare payers, with a third underway, mark significant milestones for Helius and the MS community,” Dane Andreeff, Helius’ president and CEO, said in a company press release. “We are actively pursuing broader in-network coverage for PoNS at list price from major commercial payers, while continuing to negotiate reimbursement on a case-by-case basis.”
What are the benefits of PoNS device?
People with MS often have issues with movement and balance due to problems with the transmission of electrical signals along nerve cells. While physical therapy can help recover lost function, it may become less effective as the disease progresses.
PoNS is used to improve the benefits of physical therapy and is designed to boost neuroplasticity, or the brain’s ability to rewire itself in response to new experiences, by delivering mild electrical impulses while patients are doing their exercises. The electrical impulses are delivered via a mouthpiece to the tongue, and then travel along two cranial nerves to stimulate brain regions involved in movement. The mouthpiece is connected, via a cord, to a controller worn around the neck.
PoNS was approved by the U.S. Food and Drug Administration in 2021 as a short-term treatment for walking issues in people, ages 22 and older, with mild to moderate MS symptoms. It’s cleared for use alongside a supervised therapeutic exercise program and is available by prescription only.
Data from clinical trials show that a 14-week PoNS treatment course consisting of two weeks of in-clinic treatment supervised by a certified physical therapist and 12 weeks of unsupervised therapy at home significantly improves walking and balance.
In a real-world study called PoNSTEP (NCT05437276), the benefits were sustained for up to six months, particularly in those who more closely followed the treatment protocol during the 12 weeks of unsupervised therapy.
Helius has also secured coverage from Medicare and Medicaid, and the device is available through the U.S. Department of Veterans Affairs, allowing veterans to access it through their health benefits.
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