Sight Sciences announces MACs withdrawal of local coverage determinations for MIGS
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Key takeaways:
- Five Medicare Administrative Contractors have withdrawn local coverage determinations scheduled for MIGS.
- The changes in Medicare coverage were scheduled to take effect on Jan. 29, 2024.
Five Medicare Administrative Contractors have withdrawn their final local coverage determinations for micro-invasive glaucoma surgery that were scheduled to take effect on Jan. 29, 2024, according to a press release from Sight Sciences.
The five MACs include WPS Government Health Administrators, Palmetto GBA, Celerian Group Company, National Government Services and Noridian Healthcare Solutions.
All five previously identified procedures including canaloplasty in combination with trabeculotomy ab interno, which is associated with the Omni surgical system (Sight Sciences), as investigational for glaucoma treatment in adult patients. There will now be no change to the current Medicare coverage for MIGS procedures performed with the OMNI Surgical System, the release said.
“We appreciate that the MACs and the Centers for Medicare & Medicaid Services (“CMS”) carefully and thoughtfully considered all stakeholder concerns with the LCDs and the serious potential risks to patient health and access to effective glaucoma care,” Paul Badawi, co-founder and CEO of Sight Sciences, said in the release. “We look forward to continued engagement with the MACs and CMS to ensure glaucoma patients and their physicians maintain appropriate and fair access to medically reasonable and necessary MIGS procedures and technology.
Perspective
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The MAC LCDs recommended significant cutbacks to canaloplasty, cyclophotocoagulation and goniotomy and received an overwhelming outpouring of disapproval from clinicians. The AAO, AGS and ASCRS organizations worked diligently together in fighting the LCDs.
At the heart of the issue here is the reality that those of us who take care of glaucoma patients for their entire life know that the disease is irreversibly blinding and that only earlier, safe interventions can change the disease trajectory. While there is data to support this, more data is always helpful. When the LCD was initially announced, it was clearly written by a Medicare contractor with little knowledge of the MIGS space or literature. That someone with such a poor understanding of glaucoma would propose such drastic cutbacks was shocking. To me personally, it is irksome to think about how much time our remarkably talented physicians wasted fighting off this round of attacks.
The Medicare contractors' accusations that the MIGS procedures are “experimental” proved to be unreasonable. Cooler heads prevailed and glaucoma patients will not suffer from a removal of their surgical options. This is of particular importance because MIGS procedures are the most commonly performed glaucoma procedures today, and the removal of these surgical options would undoubtedly be harmful to glaucoma patients over the long run.
For the time being, thankfully, glaucoma physicians and their patients can move forward with our current model of care. It is likely that there will be continued pressure for those of us performing MIGS procedures to provide high quality prospective and randomized data. Physicians should continue to work with each other and with industry to provide high quality data to support continued reimbursement.
The ultimate withdrawal of this LCD is, of course, welcome. But the point has been proven that Medicare administrators can move forward in unreasonable manners, and that threat continues to exist.
I think that ultimately, this issue will resurface; we won a battle, but not the war.
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