Expensive treatment is now in workers’ compensation claims.
In recent years, an expensive treatment known as MACI has been gaining traction in workers’ compensation claims. Approved by the FDA in 2016 as a biologic treatment, Matrix-Associated Autologous Chondrocyte Implantation (MACI) is used to repair localized cartilage tears in the knee. MACI has an assigned National Drug Code (NDC) making it appear that it is a true medication. It also comes as a $70,000 out-of-network bill.
What is MACI and does it work?
MACI is a process where the patient’s own cartilage is biopsied, sent to a laboratory where it is grown into a “sheet” of durable repair cartilage tissue, and returned to the surgeon for implantation back into the patient’s injured knee.
The surgeon then performs an arthroscopic procedure to clear any jagged edges on the patient’s cartilage tear and then places a piece of the newly created cartilage tissue in the exact size and shape as the tear. Following surgery, the patient must complete a yearlong rehabilitation process to ensure the best results.
MACI works in the same way blacktop works to fix one or two smaller potholes in the street. This localized treatment is used to fix one or two isolated cartilage tears. A larger tear or multiple cartilage tears caused by arthritic conditions would require a more comprehensive solution. Much like a road that is riddled with damage needs more than a pothole fill.
Clinical studies of MACI show promising results, with significant improvements in pain and function.1 Since MACI is developed from and then mimics the patient’s own cartilage this results in faster healing and lower risk of complications.
Why is MACI so expensive?
The patient-specific creation of the durable repair cartilage tissue and injury-specific nature of how it is administered make MACI an expensive treatment option. The biopsy, laboratory time and surgery make this an expensive process. In fact, we have seen this process in workers’ compensation claims as a $70,000 out-of-network bill.
Who is a candidate for MACI?
Not everyone is a candidate for MACI.
- It is reserved for a patient with an isolated injury to articular cartilage, rather than someone with a more diffuse injury caused by arthritis.
- It is partially dependent upon the willingness and ability of the patient to complete a long and arduous rehabilitation.
MyMatrixx by Evernorth actions
MyMatrixx is beginning to see MACI in workers’ compensation claims. We will monitor the use of this procedure, and we will continue discussions with our clients to determine the most appropriate solutions for their injured workers. For more questions on MACI, contact the MyMatrixx clinical team at clinical@MyMatrixx.com
1 https://www.maci.com/healthcare-professionals/about-maci/#clinical-results