![]() ![]() Pharmacotherapies (i.e., at least 2 different anti-cholinergic drugs or an anti-cholinergic and a beta-3 adrenergic receptor agonist (mirabegron)) as well as behavioral treatments (e.g., pelvic floor exercise, biofeedback, timed voids, and fluid management) have failed and.The member has experienced urge UI or symptoms of urge-frequency for at least 6 months and the condition has resulted in significant disability (the frequency and/or severity of symptoms are limiting the member's ability to participate in daily activities) and.Implantable Sacral Nerve Stimulators (e.g., Axonics and InterStim)Īetna considers permanent implantation (Stage 2) of FDA-approved implantable sacral nerve stimulators (e.g., Axonics and InterStim) medically necessary for the treatment of urge UI or symptoms of urge-frequency when all of the following criteria are met:.In such cases, further treatment with bulking agents is not considered medically necessary.Īetna considers injection of periurethral bulking agents for UI experimental and investigational for neurogenic bladder and all other indications. ![]() Members whose incontinence does not improve after 3 treatments with bulking agents are considered treatment failures and are not likely to respond to this therapy. ![]()
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