The insurer’s new coverage policy is specific to the device marketed by Pulmonx. With this Priority Health decision, some 30 million U.S. residents with commercial insurance will have Zephyr as a treatment option, if needed. Other major insurers who cover the Zephyr Valve include Humana and Aetna.
Part of an integrated health system owned by Spectrum Health, Priority Health is the second-largest health plan in Michigan, covering about 700,000 individuals.
”It is wonderful that Priority Health is offering its members access to the least invasive and most effective treatment option for severe COPD/emphysema,” Glen French, president and CEO of Pulmonx, said in a press release. “We are very pleased that many more patients in Michigan will have access to this innovative new treatment.”
The single minimally invasive procedure — there is no incision — calls for physicians to use a bronchoscope to implant an average of four small, self-expanding one-way Zephyr valves to isolate the lungs’ diseased areas, allowing the healthier lung tissue to expand and take in more air. Patients are sedated during the procedure.
The Zephyr Valve has been shown to improve the patient’s pulmonary function, shortness of breath, exercise capacity, and quality of life.
Apart from the Zephyr system, options for severe emphysema patients include invasive lung volume reduction surgery, and lung transplant.
“While there is no cure, this treatment [Zephyr Valve] can provide significant life-changing benefits without the risks of major surgery,” said Gustavo Cumbo-Nacheli, MD, pulmonologist at Spectrum Health Butterworth Hospital.
“Patients with COPD/emphysema suffer with very poor quality of life, and until the availability of the Zephyr Valve, had few treatment options that did not involve major surgery. So, this treatment is a real game-changer for these patients,” Cumbo-Nacheli said.
The device was approved in June 2018 by the U.S. Food and Drug Administration to treat patients with breathing problems caused by severe emphysema. More than 15,000 patients worldwide have been treated with the Zephyr Valve since 2007.
Of the approximately 15 million U.S. residents who have COPD, 3.5 million have emphysema. Most people with emphysema also have chronic bronchitis — inflammation of the tubes that carry air to lungs — resulting in a persistent cough.