Changes to the Australia Medical Services Advisory Committee (MSAC) framework has caused Resonance Health to put on hold any further submissions for reimbursement of FerriScan in Australia until the Company can gain more certainty as to the process for evaluation and decision-making.
FerriScan is reimbursed in some Canadian provinces as an 'Out-of-Country Medical Service'. The treating clinician must forward an application for each patient to the province's Ministry of Health (MOH) for approval. Once approved, the MOH will grant a timeframe for the patient to have their FerriScan. This funding process has been successfully used by clinicians in Ontario since 2008. Other provinces provide a funding allocation to clinicians for the provision of FerriScan to their patients
Generally, in-patients receive full reimbursement for FerriScan and have no out-of-pocket expenses.
FerriScan is reimbursed at public hospitals through the local NHS Trust system.
FerriScan has been used in the United States since 2005, when FDA clearance for FerriScan was obtained. Since that time, over 6000 FerriScans have been performed for US patients at a number of US hospitals and radiology facilities.
The cost of the MRI scan (or part of the cost) is usually covered by insurance companies (payers). Pre-authorisation is recommended, as is common for MRI testing. However, the cost associated with the FerriScan image analysis may not be covered, resulting in the hospital or patient having to cover this cost, together with any co-pay associated with the imaging.
FerriScan has now been deemed eligible for reimbursement by some US Insurance Companies:
- Blue Cross Blue Shield Massachusetts. Prior authorization is required to confirm the medical necessity of a FerriScan
- Kaiser Permanente SE Atlanta. Prior authorization is required to confirm the medical necessity of a FerriScan
- Medical Mutual of Ohio. No prior authorization is required
Resonance Health has also been working on gaining a suitable CPT code for the MRI post processing work. However, the application was rejected by the AMA in February 2014 and the Company is reviewing the most appropriate next steps regarding CPT coding for FerriScan.
While initial claims may be denied and an appeal must be initiated, this claim process is a very important part of establishing a "claims history" with each payer. Once a history of claims and a clear patient need can be demonstrated, a more formal review will eventually be undertaken by the payer. Resonance Health is happy to assist with providing supporting material required by the Medical Director of the payers or to make a presentation to the payer if required.
Rest of World
Whilst reimbursement has not yet been established, Resonance Health is continuing to work with the clinical community and patient organisations towards appropriate funding pathways for patients who need to access to FerriScan and Cardiac T2* services.