Proposal Would Deny Medicare Coverage for Spinal Disk

CMS has proposed to deny Medicare coverage for Charite, an artificial spinal disk manufactured by Johnson & Johnson, because of a lack of evidence to indicate that the surgery to implant the device is "reasonable and necessary," the Wall Street Journal reports.

CMS will hold a 30-day public comment period on the proposal to deny Medicare coverage for Charite, which costs about $11,500 and as much as $50,000 to implant, with a final decision expected within the subsequent 60-day period. The proposal to deny Medicare coverage for Charite could prompt private health insurers to take similar actions.

According to the Journal, such actions would represent a "rare setback" for J&J, which has "excelled at persuading insurers to pay for new technology." J&J does not release sales information on Charite, but Merrill Lynch predicts that annual sales of the device will decrease to $21 million this year from $41 million in 2005.

"We are disappointed by the proposed recent CMS noncoverage decision and are concerned that this action may limit access for degenerative-disk disease patients who could benefit from this technology," a spokesperson for DePuy Spine, the J&J division that markets Charite, said (Hensley, Wall Street Journal, 2/17).