Secure and energy-efficient communication between Implantable Medical Devices (IMDs) and authorized external users is attracting increasing attention these days. However, there currently exists no systematic approach to the problem, while solutions from neighboring fields, such as wireless sensor networks, are not directly transferable due to the peculiarities of the IMD domain. This work describes an original, efficient solution for secure IMD communication. A new implant system architecture is proposed, where security and main-implant functionality are made completely decoupled by running the tasks onto two separate cores. Wireless communication goes through a custom security ASIP, called SISC (Smart-Implant Security Core), which runs an energy-efficient security protocol. The security core is powered by RF-harvested energy until it performs external-reader authentication, providing an elegant defense mechanism against battery Denial-of-Service (DoS) and other, more common attacks. The system has been evaluated based on a realistic case study involving an artificial pancreas implant. When synthesized for a UMC 90nm CMOS ASIC technology, our system architecture achieves defense against unauthorized accesses having zero energy cost , running entity authentication through harvesting only 7.45μ J of RF energy from the requesting entity. In all other successfully authenticated accesses, our architecture achieves secure data exchange without affecting the performance of the main IMD functionality, adding less than 1‰ (1.3 mJ ) to the daily energy consumption of a typical implant. Compared to a singe-core, secure reference IMD, which would still be more vulnerable to some types of attacks, our secure system on chip (SoC) achieves high security levels at 56% energy savings and at an area overhead of less than 15%.