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Updated May 5

For the 39 million Americans who experience migraine headaches, noninvasive devices offer a new option for stopping painful symptoms. Insurers, however, are giving the devices the cold shoulder. 

These neuromodulation devices allow people to halt painful migraine symptoms without medication or side effects. They come in different forms, but all work by stimulating certain nerves, telling the brain to block migraine-induced pain. One such device works through remote electrical neuromodulation – or REN – while others use transcutaneous electrical nerve stimulation – or TENS. These type of devices can be good for people who haven’t responded well to traditional medications.

But while there are four such FDA-approved devices available, health plan coverage is inconsistent.

Some health plans are dragging their feet on providing coverage. Others are denying authorization requests by inaccurately classifying the devices as investigational when they’re not. In fact, no such classification exists for an FDA-approved device.

In addition to securing FDA approval, the devices have also garnered the support of migraine experts as well as the Veterans Administration. The American Migraine Foundation reports that innovative migraine technology could reduce migraine attacks and cluster headaches, noting that some devices “stop attacks that are already underway, while others are used preventively.” Notably, the VA health care system already recognizes the usefulness of some of these devices, covering them for veterans.

Nevertheless, coverage obstacles persist. 

One key to improving coverage policies may be “living” clinical guidelines that are routinely updated to reflect medical advances. Doctors and patients can cite practice guidelines in their appeals to health plans. Which is why advocates are now looking to the American Headache Society to incorporate novel migraine treatment devices in the next edition of their practice guidelines

The existing guidelines are set to “expire” in December, three years after being released. Pandemic-related travel restrictions provided a unique opportunity to expedite the guideline development process, given that meetings were held virtually.

Finalizing and releasing the guidelines earlier in the year – perhaps in June as part of Migraine and Headache Disease Awareness Month – would allow time for payers to consider the new guidelines before locking in their covered services for the 2022 plan year. If the guidelines aren’t released until later in 2021, health plan coverage will almost certainly lag another year.

Migraine disease exists on a spectrum and treatment efficacy can vary significantly from one patient to another. By acknowledging FDA-approved devices as another valid treatment option, health plans can clear the path for the patient-centered approach that people living with migraine disease need. 

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