Coflex Insurance Coverage

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Part
01

Coflex Insurance Coverage

While there is no publicly available information to fully note the number/percentage of US Coflex procedures covered by insurance with a breakdown by type of coverage, there was detail available on interspinous devices that may be valuable. Further and unfortunately, the revenue of Paradigm Spine given in the previous report must have been a typographical error as the original publication reported that the most recent available revenue was $12.2 million, not $422.2 million. Below please find an outline of the research strategies used in order to better understand why the information requested is publicly unavailable.

DISCREPANCY

  • Due to a lack of publicly available information, we were unable to estimate the percentage of interspinous device implants that were covered by state-based government programs.
  • The revenue of Paradigm Spine is $12.2 million, not $422.2 million.
  • Paradigm Spine did have a TTM (trailing twelve months) revenue of $40 million in 2018.
  • Hoovers quotes Paradigm's revenue to be ~$8.46 million which is much lower than other reports. However, it places the actual revenue to be within ~$10 million which is in line with the claim of ~$12 million.

OTHER USEFUL FINDINGS

  • About 66.7% of interspinous device patients have Medicare insurance covering the ID implant while 23.1% of patients with ID implants have private insurance coverage for their devices.
  • First Coast Service Options has program coverage for some interspinous process decompression IPD devices.
  • Cahaba Government Benefit Administrators' program potentially covers interspinous devices in some states since it doesn't specifically mention criteria for inclusion or exclusion of IPDs.
  • Other interspinous devices include X-STOP, WALLIS, DIAM, Aperius PercLID, Superion, Helifix, and In-Space.

Research Strategy

To confirm, the corrected revenue of $40M that was previously found was verified in this research. Paradigm Spine did have a revenue of $40 million in 2018 as its TTM revenue over the months of 2018. Since the company is a private company, although we checked for financial reports and investor reports, we couldn't find any to pinpoint its actual revenue.

Due to the lack of publicly available information, we were unable to estimate the percentage of interspinous device implants that were covered by state-based government programs. We looked for reports, articles, publications, and others on insurance and related programs for an interspinous device on several state government Medicare, Medicaid, and related platforms. These included HANYS, NCDHHS, HealthCare.gov, VDH, AND so on. The information available was on insurance coverage for some specific interspinous devices and no mention was made to the percentage of such devices that were covered by such policies. The only reference to the devices, in general, was that there were no national coverage plans for these devices. This might be because the devices are considered to be merely investigative by experts.

Then, we identified the interspinous devices that govern the market in the United States. Our initial intention was to find all the interspinous devices available in the United States and look for possible insurance policies covering each of them, but we were only able to find the devices that govern the market and considered them sufficient to be used to represent the market. We searched for the state government programs covering each of these devices. For this, we leveraged reputable databases, industry news and knowledge platforms like Spinal News International, NIH, Health.gov, Health Finder, New York State Department of Health, and so forth. However, we were not able to dive deep for this and we were able to find coverage for some (but not all) the devices. This is probably because some of these devices aren't covered by state government programs as they are considered to be also just investigative or not medically necessary.

Next, we looked for the percentage of patients undergoing the implants that had their ID implants covered by state-based government insurance programs. For this, we utilized Journal Space, Research Gate, NCBI, HHS, and others. However, much of this data was also unavailable.
Sources
Sources

Quotes
  • "IPDs including X-STOP (IDD; Kyphon, Sunnyvale, California), WALLIS (ISS; Abbott Spine, Austin Texas), DIAM (ISS; Medtronic, Memphis, Tennessee), and Aperius PercLID (IDD; Medtronic, Memphis, Tennessee) and compare them to the next-generation tech- nologies of Coflex (ISS; Paradigm Spine, New York, New Yo rk ), Supe rion ( IDD; Ve rtiFlex, San Clemente, California), Helifix (IDD; Alphatec Spine, Carlsbad, California), and In-Space (IDD; DePuySynthes, West Chester, Pennsylvania)."
Quotes
  • "the percentage of patients undergoing ID placement with Medicare decreased from 79.7% to 66.7% while private insurance coverage for ID placement increased from 13.5% to 23.1%"