Oregon: Cover Acellular Dermal Matrix
ASPS was informed that the Oregon Health Evidence Review Commission (HERC) was considering a review of whether the state's Medicaid program, the Oregon Health Plan, should continue noncoverage of acellular dermal matrix (ADM) in breast reconstruction earlier this year. Through conversations with HERC staff and Oregon-based plastic surgeons, the discussion was scheduled for the August 8 HERC Value-based Benefits Subcommittee (VbBS) meeting.
Following the scheduling of the hearing, ASPS began outreach to plastic surgeons in the state and worked to secure member Allen Gabriel, MD, to provide expert testimony. In addition to that outreach, ASPS crafted comments outlining the Society's request for the state to cover ADMs. As use of ADMs in breast reconstruction is now the standard of care and by far the most prevalent method used in breast reconstruction, ASPS does not believe the state should place additional burdens on breast cancer survivors by continuing noncoverage.
During the hearing, HERC VbBS members received a review of the evidence from HERC Medical Director Ariel Smits, MD, prior to Dr. Gabriel's testimony. Dr. Gabriel reiterated the Society's stance regarding standard of care and highlighted the overwhelming number of procedures in 2019, including the fact that younger plastic surgeons are primarily trained to utilize ADMs in breast reconstruction. Unfortunately, following the evidence review, Dr. Gabriel's testimony on behalf of ASPS, and a question and answer session where panelists asked Dr. Gabriel multiple questions, the VbBS voted to continue noncoverage. The subcommittee cited the fact that many coordinated care organizations have the option to cover ADM regardless of HERC guidance and that they would like to see more evidence from randomized controlled critical trials before reevaluating the issue.
ASPS is displeased with the state's decision and will continue to engage the state in an effort to overturn the decision.