CIGNA CKC Bulletin

Cigna CKC Bulletin

The CyberKnife Coalition (CKC) is pleased to share some important and exciting changes in national coverage for CyberKnife. Effective June 15, 2012, the national commercial insurance plan, Cigna, will cover SBRT to treat prostate cancer.

Background

Cigna insures approximately 12.6 million lives primarily in the states of Arizona, California, Colorado, Connecticut, Florida, Georgia, North Carolina, South Carolina, Texas, and Tennessee.

Over the past several years Cigna’s views on SBRT have been evolving and the policy has included several key extracranial indications suitable for CyberKnife treatment (e.g. spine, operable and inoperable lung, liver, and renal). Nonetheless, Cigna has always considered prostate cancer as investigational and non payable.

Earlier this year, as Cigna began its annual policy review, CKC members, including leading clinicians in the area of prostate cancer treatment and research, engaged with Cigna to educate their medical policy team on the latest clinical data. In June, based, in part, on this education and outreach, Cigna updated its SBRT medical policy to include coverage for prostate cancer.

Policy and Coverage Information

Cigna’s updated coverage policy can be found on its website at the following html address: http://www.cigna.com/assets/docs/health-care- professionals/coverage_positions/mm_0110_coveragepositioncriteria_stereotactic_r adiosurgery_srs.pdf.

In addition to prostate cancer, Cigna has also expanded its policy to include coverage for the following diagnoses:

  • Recurrent brain metastasis in an individual who has not received whole brain radiotherapy and has controlled systemic disease
  • Symptomatic pulmonary metastasis in an individual with good performance status and controlled systemic disease
  • Metastatic renal cell carcinoma (RCC) to the spine
  • Metastatic RCC to the brain
  • Unresectable hepatocellular carcinoma (HCC) (previously “liver tumors”)
  • Metastatic colorectal cancer to the liver

Cigna’s updated policy also clarifies the clinical criteria required for coverage of diagnoses included in earlier versions of the policy. We encourage you to check the latest version to familiarize yourself with the updated criteria.

We are pleased to be able to share news of another national commercial insurance plan realizing the clinical effectiveness and patient benefits of SBRT and CyberKnife.

We look forward to continuing our work with our member centers and the payer community to ensure that all appropriate patients have access to the CyberKnife technology.