Posted , 7 users are following.
Since the new Eyhance lens is technically a monofocal lens, any opinions as to whether US Medicare will cover the cost of those lenses as they do traditional monofocal lenses? Just curious as I have possible cataract surgery coming up in the near future.
0 likes, 9 replies
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RonAKA bricks609
Posted
I have no inside knowledge other than health plans try to get away with spending the least amount possible. I suspect the Eyhance will be like the Vivity and be considered a premium lens. If it costs the practitioner more than a monofocal lens (and it most likely will) then basic health plans are not going to cover it. That said I understand in Quebec where they get lots of welfare money from other provinces, they will cover the cost of a premium lens!
bricks609 RonAKA
Posted
That is kind of what I figured too. I was just curious as the Eyhance is TECHNICALLY called a monofocal lens, and I think Vivity is TECHNICALLY called a EDOF lens. But I do follow your line of thinking, and figured there would be a way to consider the Eyhance a premium lens even though it is a monofocal lens.
RonAKA bricks609
Posted
I think they both use the same basic technique to extend the depth of focus. They deviate from a single point aspheric shape to the lens. I recall the Eyhance deviates from the perfect aspheric shape gradually from the middle to the outside of the lens, while the Vivity does it in a small step on the lens. Or at least that is how I have rationalized it. But the technology likely will have little to do with it and it will come down to cost. I suspect there is no additional cost to make either of these lenses vs the cost to make a standard monofocal lens. But, they will have invested a lot of money into the research that they of course will want to recover one way or another. I'd be extremely surprised if that does not result in a premium price.
xen42188 bricks609
Posted
Some hospitals in EU have replaced their mono stocks with Eyhance (of course what jj would like them to do as well 😃 and use Eyhance as their go to mono. I remember seeing a recent IOL price list for Canada and there really isnt much of a difference in price to a mono. Eyhance from what I recall was in the 250-300 range (compared to 1200-1300 for the edof/tris). This is just to provide relative comparison and I'd highly suggest considering bridging the gap beyond what health plans would cover for someone who otherwise is a good candidate for Eyhance for that extra one line of VA.
billy111 bricks609
Posted
Yes, the Tecnis Eyhance Monofocal is covered by Medicare, The Tecnis Eyhance Toric Monofocal is not covered by Medicare. Per my Google search and what my cataract surgeon told me,
greg59 bricks609
Posted
Yesterday, I had to pay extra for the Eyhance, despite having good US insurance. Not as much as a multifocal (~$2500 extra per eye) or Vivity (~$2000 extra), but about $1100 per eye. My insurance covers the same as Medicare so I'd have paid the same if I was on Medicare.
J&J is marketing Eyhance as one of the only "premium" monofocals. They target "premium" surgeons in the US. I doubt they'd want it used as a standard monofocal with full non-premium Medicare reimbursement because the overall profits on the lens might fall.
If other manufacturers start selling similar products in the "monofocal" segment and future studies indicate they are just better monofocals then perhaps Medicare would start reimbursing fully. But they aren't going to fork over the extra $1100 per eye that I paid. Medicare covering Eyhance-like premium monofocals seems several years off at this point, if it ever happens.
billy111 greg59
Posted
If you paid $1,100 for an Eyhance monofocal, it must have been the Tecnis Eyhance Toric II Monofocal IOL. I was also quoted that price. Medicare will cover the cost of the Tecnis Eyhance non-toric Monofocal.
Google "Medicare Reimbursement for the Tecnis Eyhance IOL"
greg59 billy111
Posted
I did not get a toric. Paid for the regular Eyhance. May have been ripped off if medicare pays for the regular Eyhance.