Radiology advocacy pays off, with BCBS affiliate revoking controversial imaging pay policy
Recent radiology advocacy has paid off, with a Blue Cross Blue Shield affiliate revoking a controversial imaging pay policy.
BCBS of Arkansas’ decision pertains to gadopiclenol, a gadolinium-based product sold under the brand names Elucirem and Vueway. The drug is used to detect and visualize lesions in the central nervous system and body. However, Arkansas’ largest health insurance company, with over 800,000 members, had started rejecting reimbursement requests for injection of 1 ml gadopiclenol.
The American Society of Neuroradiology alerted its members about the change in December and wrote a letter to BCBS of Arkansas, asking it to reconsider the update. A few months later, the payer has responded.
“We recently received news that the Arkansas BCBS non-covered list has been updated and gadopiclenol (A9573) is no longer included,” the society said in an update published Tuesday. “We are delighted with Arkansas BCBS’s coverage decision.”
ASNR noted in December that the FDA-approved dose for gadopiclenol is 0.05 mmol/kg, which is half the amount for other gadolinium-based contrast agents OK’d for use in MR imaging of the central nervous system. Medicare and most other commercial cover the GBCA, which has demonstrated “excellent” diagnostic performance and safe outcomes, as supported by “robust” clinical evidence.
“It is critical to clarify that gadopiclenol is not an investigational drug, but a thoroughly studied and validated agent,” ASNR President Max Wintermark, MD, wrote in a Dec. 2 letter to BCBS of Arkansas’ chief medical officer.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.