As of May 15, 2015, Aetna is implementing a new policy on the use of power morcellation in the removal of uterine fibroids. Myomectomy and hysterectomy procedures that use a power morcellator will not be covered in most circumstances because the safety and efficacy of this approach has not been demonstrated. Aetna will require doctors to precertify myomectomies or hysterectomies that use a power morcellator.
Doctors can request a clinical exception for coverage if:
- The patient is pre-menopausal, wants to maintain her fertility and another surgical or non-surgical fibroid treatment wouldn’t be effective; and/or
- The patient has severe comorbidities where the risk of death or severe morbidity of another procedure outweighs the risk of an undiagnosed sarcoma.
The policy takes into account the latest FDA warnings about the risk that morcellation can spread unsuspected uterine sarcoma in the abdomen and pelvis. The FDA now estimates that approximately 1 in 350 women undergoing hysterectomy or myomectomy for the treatment of fibroids has an unsuspected uterine sarcoma. This is higher than previous estimates.
Aetna is encouraging doctors to talk to patients about the risks and benefits of morcellation, and its alternatives.