Medi-Cal Expands Access to SNM Therapy

Collaborative effort success! Medi-Cal Expands Access to SNM Therapy

Big team win for CUA advocacy! Congrats to all who worked on this effort to alleviate the disparity in access to Sacral Neuromodulation Therapy for incontinence issues for Medi-Cal patients.

With the help of the Medtronic team and the CUA leadership, including Dr. Seth Cohen, Dr. Rob Lurvey, Dr. John Lam, and Dr. Polina Reyblat, Medi-Cal now covers SNM therapy for OAB & FI.

The impetus for this effort came from CUA member at UCSD, Dr. Yahir Santiago-Lastra. We are grateful to Dr. Santiago-Lastra for highlighting this need and engaging with us to bring this important change at the state level to fruition.

CUA Leader, Dr. Seth Cohen says, “This is absolutely a significant win for patients suffering with pelvic floor disorders in California that have traditionally not had access to this therapy; our Medi-Cal patients deserve the same care as all patients."

Now thousands of people will have access to this life-changing therapy.

This helps to close health inequities given that Medi-Cal prescribers are:

53.1% female
48.4% Hispanic
9.2% Asian
6.9% African American

Many thanks to the team at Medtronic for their assistance in bringing us to success.

The policy coverage was effective starting May 15, 2023. Refer to page 17 which outlines SNM coverage requirements for overactive bladder, urinary urge incontinence, urgency-frequency, and non-obstructive urinary retention. This long-established therapy has been proven to help patients suffering from these difficult conditions and is especially important for patients for whom other therapies have not been effective. The need for this therapy is great as 1 in 6¹adults in the U.S. has overactive bladder (OAB), and 1 in 12^2,3 adults in the U.S. has fecal incontinence (FI). Please work with your Medtronic rep to discuss how to expand access by helping your Medi-Cal patients with OAB and FI regain control with InterStim™ therapy.