Increased Insurance Coverage for Transcranial Magnetic Stimulation will Accelerate Demand

            Transcranial Magnetic Stimulation has been consistently growing since 2008 when it was first FDA-approved for the treatment of depression in the United States. It is now approved for Obsessive-Compulsive Disorder, Cigarette smoking cessation, Anxious Depression, and Migraines. It is also being used for Post-Traumatic Stress Disorder (PTSD), Schizophrenia symptoms, and Bipolar Depression. It is being researched as a treatment for multiple neurological disorders including multiple sclerosis, autism, and Parkinson's. The adult market share for TMS is the largest group but as continued studies on treatment for various illnesses in children progress, the child and adolescent market share will grow over time. 

       According to the research article, "Transcranial Magnetic Stimulation, Market Size, Growth Trend Report 2022 to 2030"published 08/29/222 (www.biospace.com) , the global growth in TMS was $1.7. billion in 2021 and $1.29 billion in 2023 with an anticipated growth to $2.5 billion by 2030. This will lead to more coverage for TMS worldwide and more approved uses for TMS. The child market and neurological market for TMS will continue to grow as well as the number of doctors and clinics offering the treatments. The United States demand for TMS was 40 percent of the worldwide market in 2021, suggesting a lot of growth and potential outside of the United States. 

     Two of the major TMS manufacturers have stated their most recent statistics on the number of people treated by their devices. The Brainsway Deep TMS device (which we use) has treated over 100,000 patients. It was FDA-approved in 2013 for Major Depressive Disorder and in 2018 for OCD. Neurostar has treated over 165000 patients worldwide so far. 

    The growth of TMS in America will be facilitated by increasing acceptance among health insurance companies as shown as by their easing of the number of failed therapies prior to paying for TMS. Prior to 2022, insurance companies required patients to have failed 4 or more antidepressants from at least 2 different classes, plus 1 medication added to augment or boost an antidepressant to see if it helps, and psychotherapy during the current episode of depression before agreeing to cover TMS for treatment-resistant depression. This was quite a hurdle. 

   As of January 2024, all the insurance companies have made TMS more accessible to patients. A recent review of the health insurance companies in Texas revealed the following requirements for TMS to be covered. This list  is subject to change and may vary from state to state.

Aetna - requires a failure of 2 antidepressants of different classes and a failure of at least 1 Augmenting agent (like Abilify or Seroquel)

BCBS- requires failure of 2 antidepressants of different classes and failure of an adequate course of psychotherapy in the episode of depression

Cigna - requires the 2 antidepressants of different classes and psychotherapy

Humana - requires failure of 4 antidepressants of at least 2 different classes and psychotherapy 

Magellan - requires the failure of 2 antidepressants of different classes and psychotherapy

Medicare - requires the failure of 1 antidepressant prior to approving TMS. The lowest requirement opening up TMS to most eligible depressed people covered by traditional Medicare.

United Healthcare - requires failure of 2 different antidepressants of different classes

Hopefully, with time, all these insurance companies will cover TMS like Medicare does. The FDA approved TMS in 2008 for anyone with major depression disorder who has failed at least one course (not 2,3 or 4 courses) of antidepressant treatment of an adequate dosage and duration. Most insurance companies REQUIRE the diagnosis of Major Depression of Moderate to Severe Intensity (without psychotic features). Some insurance companies will cover TMS for Obsessive Compulsive Disorder, which has it's own set of requirements.

The following conditions are CONTRAINDICATIONS to TMS and insurance coverage of TMS: 1)Psychotic Disorders  2)Bipolar Disorder 3)Active Suicidal plans or recent attempts 4) Neurological Diseases (such as Epilepsy, increased intracranial pressure or Tumors) 5)Magnetic material in the head (such as shrapnel, clips, stents, cochlear implants, bullet fragments or vagal nerve stimulator leads in the neck). 6)Lastly Pregnancy is a contraindication due to lack of research data. It is likely that TMS is safer for the fetus than medication with less risk of drug induced side effects or long term consequences.

If you or someone you know would benefit from TMS, please contact Houston West TMS at 713-464-4455. We will be glad to answer your questions and help you on your journey to wellness.