Honor Anthem Coverage and Reimburse FDA-Cleared Migraine Treatment!

We, the undersigned patients, caregivers, healthcare professionals, and advocates, urge Anthem (Elevance Health) to reimburse Nerivio, a migraine treatment device cleared by the FDA, at levels that reflect the actual cost of care and honor Anthem's existing medical policy.

We appreciate Anthem's recognition of Nerivio as a medically appropriate treatment option and its acknowledgment of the important role non-pharmacologic therapies play in migraine care. However, current reimbursement and claims practices prevent many patients from meaningfully accessing this covered benefit. Reimbursement falls well short of the cost of care, leaving patients with substantial out-of-pocket costs and turning a covered benefit into an unaffordable one. Patients and providers also encounter outright denials, delayed processing, and inconsistent application of policy standards. The cumulative effect is the same: medically necessary care becomes inaccessible.

Migraine is a disabling neurological disease that affects employment, family life, mental health, and overall quality of life. Many patients have exhausted traditional therapies, experienced intolerable side effects, or remain inadequately treated despite years of care. Nerivio offers an important non-pharmaceutical option for patients, including those who cannot tolerate, do not respond to, or should not use conventional medications — but only if they can afford to access it. Supporting timely access to evidence-based, non-pharmacologic migraine treatment may also help reduce downstream healthcare costs associated with poorly controlled migraine, including emergency department visits, urgent care utilization, repeated specialist appointments, and medication-related complications.

We recognize that reimbursement of a newer migraine treatment device cleared by the FDA presents challenges in the absence of an established CMS DMEPOS fee schedule for code A4540. However, methodologies that substantially undervalue the actual cost and clinical value of the therapy create significant barriers to access — and when reimbursement fails to support access, a covered therapy becomes effectively unavailable despite Anthem's determination that it is medically appropriate.

The downstream consequences of inadequate reimbursement can include:

• Increased migraine frequency and severity
• Missed work and lost productivity
• More emergency department visits and higher healthcare utilization
• Medication overuse and avoidable side effects
• Financial hardship and treatment abandonment due to unaffordable out-of-pocket costs

We request that Anthem:

1. Reimburse Nerivio claims at levels that reflect the actual cost of care
2. Review and correct underpaid claims involving migraine device therapy cleared by the FDA
3. Apply timely, transparent, and consistent claims review and payment practices
4. Provide clear coding, billing, and reimbursement guidance to providers
5. Work with patients, providers, and headache specialists to ensure reimbursement keeps pace with evidence-based migraine care

When reimbursement falls short of the cost of care, coverage exists on paper but not in practice. Patients should not face insurmountable financial barriers to a therapy Anthem has already determined warrants coverage. We urge Anthem to align reimbursement with its own coverage decisions and ensure equitable access to migraine care.

Respectfully,

Anthem Patients listed on this Petition