Insurance Coverage for Corneal Collagen Crosslinking (January 2018)

Corneal Crosslinking Insurance Coverage in the United States January 2018

Cost of Corneal Crossllinking

There is limited evidence on the costs of corneal crosslinking, but it may be as high as $2,500 to $4,000 per eye in the United States. a cost-effectiveness study estimated the costs of the total treatment for one person as £928 in the UK National Health Service.

FDA-Approved Crosslinking Method

FDA has approved corneal collagen crosslinking (CXL) for progressive keratoconus in April 2016. this approval only covers the crosslinking products developed by Avedro, Inc. this FDA-approved method involves corneal epithelial debridment, hence it is known as epithelium-off or epi-off crosslinking.

Insurance Coverage in the United States

Since FDA approval in April 2016, many insurance companies have started covering corneal collagen crosslinking (CXL) for progressive keratoconus and keratectasia. Below is an updated list of insurance companies in the United States that cover corneal collagen crosslinking (CXL) for progressive keratoconus.

Payer Name Payer Region Notes
Aetna National
Arkansas Blue Cross Blue Shield AR
Blue Cross Blue Sheild of Mississippi MS
Blue Cross Blue Shield FEP National
Blue Cross Blue Shield of Alabama AL
Blue Cross Blue Shield of Arizona AZ
Blue Cross Blue Shield of Illinois IL
Blue Cross Blue Shield of Kansas KS
Blue Cross Blue Shield of Kansas City Kansas City, Northwestern MO, Johnson & Wyandotte Counties
Blue Cross Blue Shield of Louisiana LA
Blue Cross Blue Shield of Massachusetts MA
Blue Cross Blue Shield of Michigan MI
Blue Cross Blue Shield of Montana MT
Blue Cross Blue Shield of New Mexico NM
Blue Cross Blue Shield of Oklahoma OK
Blue Cross Blue Shield of Rhode Island RI, CT, MA
Blue Cross Blue Shield of South Carolina SC
Blue Cross Blue Shield of Tennessee TN
Blue Cross Blue Shield of Texas TX
Blue Cross of Idaho ID Coverage to begin on 12/15/2017.
Blue Shield of California CA
CareFirst Blue Cross Blue Shield MD, DC, Northern VA
Dean Health Plan WI
Hawaii Medical Service Association HI Coverage begin on 2/1/2018.
Horizon Blue Cross of New Jersey NJ
Independence Blue Cross PA, NJ, DE, MD
John Hopkins HealthCare MD
Kaiser Permanente AZ, CA, CO, DC, GA, HI, MD, NV, TX, VA, WA
Medical Health Plans MN, WI, ND, SD
Regence Blue Cross Blue Shield ID, OR, UT, WA
Tricare Available to all Tricare beneficiaries, including dependents. also see this comment.
This list is subject to change. It is not intended to be a directive, nor is it a suggestion about the likelihood of coverage or reimbursement. Please confirm with your individual carriers. Source: Avedro, Inc.

Avedro's ARCH Program

The ARCH (Avedro Reimbursement Customer Hub) program is a three tiered service to help keratoconus patients with reimbursement questions, prescription assistance and the possibility of financial assistance for eligible patients.

Call the ARCH Hotline 844-528-3311 for questions about coding, billing, claims submissions or payer coverage for corneal cross-linking with Photrexa® Viscous and Photrexa® with the KXL® System.

Visit Avedro's website to learn more about insurance coverage and find cornea specialist who perform corneal crosslinking.

Learn more about corneal collagen crosslinking (CXL)


3 comments:

  1. Please update this list to include Tricare Prime, which covered this procedure for my son in both eyes, with a referral from our primary care doctor to the corneal specialist. It was covered at 100%. He had the first eye done in June of 2017 and the second eye done in August of 2017.

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    Replies
    1. Thank you. we have updated the list and referenced your Facebook comment too.

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  2. CAn you provide more context on the insurance coverage side of things? I saw BCBS of Illinois on your list, but was not able to find the resource on Avedros website that matched that? Also whats the best way to get this covered? One of the docs i saw said it was unlikely and that Avedro upped the price of the drug by 2x so that the CXL procedure is now in the order of $5000-$7000 per eye.

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