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Apligraf® commercial insurance coverage support.

When it comes to treating VLUs and DFUs, 100% of commercial medical policies cover Apligraf.*1 The commercial payer summary guidelines below show what the policies are for a number of insurance providers.

Commercial insurance coverage

100%

of commercial medical policies cover Apligraf treatment for VLUs and DFUs*1

Commercial payer summary guidelines

Aetna Wound Care Policy #0244

Effective: 05/28/1998
Last Review: 07/29/2022

Aetna Wound Care Policy #0244 Source: http://www.aetna.com/cpb/medical/data/200_299/0244.html

Anthem Medical Coverage Policy #SURG 00011

Allogeneic, Xenographic, Synthetic and Composite Products for Wound Healing and Soft Tissue Grafting

Effective: 06/29/2022
Last Review: 05/12/2022

Anthem Medical Coverage Policy #SURG 00011 Source: https://www.anthem.com/dam/medpolicies/abcbs/active/policies/mp_pw_a053309.html Only Grafix Prime is covered for DFUs.

BC/BS Federal Employee Program

Bioengineered Skin and Soft Tissue Substitutes Policy #FEP7.01.113

Effective 04/01/2022

Amniotic Membrane and Amniotic Fluid Policy #FEP 7.01.149

Effective: 07/01/2022

BC/BS Federal Employee Program Sources: https://www.fepblue.org/-/media/PDFs/Medical%20Policies/3-18-2022/Medical_Policies/701113%20Bioengineered%20Skin%20and%20Soft%20Tissue.pdf https://www.fepblue.org/-/media/PDFs/Medical%20Policies/07-06-2022/701149%20Amniotic%20Membrane%20and%20Amniotic.pdf

BC/BS Highmark Commercial Medical Policy—Pennsylvania #S-33-035 & #S-249-007

Effective: 01/01/2021
Last Review: 12/21/2020



BC/BS Highmark Commercial Medical Policy - Pennsylvania #S-33-035 & #S-249-007 Sources: https://securecms.highmark.com/content/medpolicy/en/highmark/pa/commercial/policies/Surgery/S-33/S-33-035.html https://securecms.highmark.com/content/medpolicy/en/highmark/pa/commercial/policies/Surgery/S-249/S-249-007.html

Cigna Medical Policy #0068

Tissue-Engineered Skin Substitutes

Effective: 05/15/2022
Next Review: 03/15/2023

Cigna Medical Policy #0068 Source: https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0068_coveragepositioncriteria_woundhealing.pdf

Excellus Medical Coverage Policy #7.01.35

Bioengineered Tissue Products for Wound Treatment and Surgical Interventions

Effective: 04/15/2021

Excellus Medical Coverage Policy #7.01.35 Source: https://provider.excellusbcbs.com/documents/20152/127121/bioengineered-tissue-products.pdf/ae9812e6-205c-a3a3-4377-c1e367687672?t=1563463233746

Humana Medical Policy #HCS-0370-039

Skin and Tissue Substitutes

Effective: 06/23/2022
Last Review: 01/27/2022

Humana Medical Policy #HCS-0370-039 Source: https://dctm.humana.com/Mentor/Web/v.aspx?objectID=0900092982efa7d9&searchID=79c54fc6-5303-4a02-9b7f-23facd9744fe&dl=1 Grafix Core and Grafix Prime.

Medica Tissue-Engineered Skin Substitutes for Wound and Surgical Care

Effective: 02/16/2022

Medica Tissue-Engineered Skin Substitutes for Wound and Surgical Care Source: https://partner.medica.com/-/media/documents/provider/coverage-policies/tissue-engineered-skin-substitutes-cp.pdf?la=en

United Health Care Commercial Medical Policy #2020T0592H

Effective: 07/01/2022

United Health Care Commercial Medical Policy #2020T0592H Source: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/skin-soft-tissue-substitutes.pdf

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Please refer to the Apligraf Package Insert for complete prescribing information.

The coverage information provided shall not be construed as a statement, promise, or guarantee that reimbursement will be received. Reimbursement requirements are subject to change at any time. Check with your local payer regularly. *Insurance coverage varies by payer and is subject to change at any time. Confirm with your current applicable payer policies for up-to-date Apligraf coverage requirements and policies. EpiFix is a registered trademark of MiMedx Group Inc. Grafix is a registered trademark of Osiris Therapeutics, Inc. TheraSkin is a registered trademark of Solsys Medical, LLC.

REFERENCE:

  1. Data on file. Organogenesis Inc.