Infusion Pumps

Aetna covers FDA‑approved implanted infusion pumps when the drug must be delivered by an implanted pump and is medically necessary — specifically intrathecal baclofen for intractable spasticity (spinal cord disease/injury, stroke, MS, stiff person syndrome) and implanted intrathecal/epidural administration of opioids, ziconotide or clonidine for severe chronic intractable pain when less invasive therapies have failed and a successful trial supports implantation. Key requirements/exclusions: documented favorable trial response is required (single intrathecal bolus ≤100 mcg for baclofen with no pump if nonresponsive; failed ≥6‑week noninvasive therapy and a positive trial for spasticity; 1–2 day inpatient trial with ≥50% pain relief and acceptable side effects plus psychological evaluation for nonmalignant pain), pumps are not covered with contraindications (active infection, insufficient body size, allergy, device crosstalk), replacement pumps adding only wireless monitoring are not necessary, and many other uses (e.g., baclofen for cancer pain/neuromyotonia/RA or combined with other agents; pumps for insulin, heparin, most intrahepatic chemotherapy, gastroparesis, external pumps for unlisted indications) are considered investigational/not covered.