There are five words that can break a doctor’s heart: ‘my insurance doesn’t cover it’. The patient who says this to a doctor is essentially rejecting treatment because it’s not covered by insurance and the patient has no means to pay for it. Unfortunately, such statements are spoken all too frequently by patients who could otherwise be successfully treated with regenerative medicine.
Procedures like platelet-rich plasma (PRP) and stem cell therapies have proven themselves beneficial among people who can afford them. The problem is, insurance companies do not cover the procedures except under rare circumstances. The question many patients are asking now is whether insurance companies will ever cover regenerative medicine.
There is hope if you are willing to step back and look at what’s happening within the broad arena that is modern medicine. Four emerging factors suggest that insurance companies will, at some point in the future, begin covering PRP and stem cell therapies for orthopedic conditions, hair loss, and aesthetic medicine.
1. The 21st Century Cures Act
Congress passed the 21st Century Cures Act back in December 2016 to very little media fanfare. In fact, the average American is completely unaware of its existence. The legislation authorized $6.3 billion in funding for the National Institutes of Health and other agencies for the purposes of speeding up the FDA approval process for drugs and medical procedures.
Passage of the 21st Century Cures Act should mean a more streamlined and less expensive process for new approving therapies in the future. Faster and less costly FDA approval would motivate more organizations to submit regenerative medicine procedures.
2. U.S. Market Growth
There is little denying that the market for regenerative medicine services is growing. According to a Reuters report published last spring, the U.S. regenerative medicine market is expected to grow upwards of 33% over the next several years. Insurance companies, always wanting to get their slice of the pie, are not going to ignore that kind of growth forever. At some point, they will be compelled to get on board.
3. More Doctors Training
ApexBiologix.com, a Utah company that trains doctors in regenerative medicine procedures, has already helped hundreds of doctors and clinics get set up to offer both PRP and stem cell treatments. The thing is, Apex Biologix is not alone. There are several similar companies around the country training doctors who want to begin offering regenerative medicine as an alternative. Once the number of doctors reaches a tipping point, insurance companies are going to have to cover the procedures or start losing doctors who drop out of their networks.
4. Consumer Demand
Last but not least is the old standby known as consumer demand. We still live in a market-driven economy, and that goes for medical treatments. Consumers almost always get what they want as long as they’re willing to fight for it. That’s exactly what they are doing with regenerative medicine.
Just like consumers pressured insurance companies for over a decade to start covering things like chiropractic and acupuncture, they are beginning to put the pressure on for regenerative medicine coverage. Combine that with the repeal of the individual mandate as part of GOP tax reform, and there’s a real possibility that some of the biggest insurance companies will start seeing a drop in subscribers unless they get on board.
Insurance companies are not covering regenerative medicine procedures yet. However, there are signs suggesting things may change in the future. It may be only a matter of time before coverage for PRP and stem cell treatments are standard.