UnitedHealthcare Expands EXPAREL Reimbursement, Boosting Non-Opioid Pain Management Access
Event summary
- UnitedHealthcare now provides separate reimbursement for EXPAREL across outpatient settings, including hospital outpatient departments and ambulatory surgery centers.
- This update enables EXPAREL to be reimbursed outside of the surgical bundle for eligible UnitedHealthcare members, representing an additional step in expanding access to non-opioid postsurgical pain management options.
- With approximately 40 million covered lives, UnitedHealthcare is the largest health insurer in the United States.
- In total, approximately 150 million covered lives now have access to separate reimbursement for EXPAREL, representing roughly half of all medical lives nationwide.
The big picture
This milestone with UnitedHealthcare reflects important momentum towards expanding access to non-opioid pain management for patients across the country. The update ensures patients have greater access to safe, effective pain management options during and after surgery without the burden of financial barriers. Historically, reimbursement uncertainty and bundled payment structures have posed significant barriers to adoption of non-opioid therapies in outpatient surgical settings.
What we're watching
- Adoption Momentum
- How the pace of adoption will build over time with UnitedHealthcare's reimbursement update.
- Market Expansion
- Whether Pacira can sustain this momentum with other major payers to further expand EXPAREL's reach.
- Clinical Decision-Making
- The impact of broader adoption of separate reimbursement policies on clinical decision-making and economic considerations.
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