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New policy criteria for treatment of osteoarthritis of the knee 

October 3, 2019    

Effective January 1, 2020, our medical policy on hyaluronate acid (HA) products will reflect new coverage criteria, including the addition of Monovisc® as a fourth preferred product in the HA class, along with Orthovisc®, Synvisc®, and Synvisc-One®. As a result, Monovisc will no longer require precertification for AmeriHealth members.

Medical Policy #11.14.07u: Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis was posted as a Notification on October 3, 2019, and will go into effect January 1, 2020.

Background

There are 16 HA products that have been approved by the U.S. Food and Drug Administration to treat osteoarthritis of the knee:

  • Durolane®
  • Euflexxa®
  • Gel-One®
  • Gelsyn-3™
  • GenVisc 850®
  • Hyalgan®
  • Hymovis®
  • Monovisc®
  • Orthovisc®
  • Supartz®
  • Synojoynt™
  • Synvisc®
  • Synvisc-One®
  • Triluron™
  • TriVisc®
  • VISCO-3™

Although there are many hyaluronate acid products on the market for the treatment of osteoarthritis of the knee, there is no reliable evidence of the superiority of any one brand compared to the others.

Coverage criteria


All HA products are eligible for coverage in accordance with the member’s benefit plan and the criteria listed in our medical policy. Cost-sharing (e.g., copayment, deductible, and coinsurance) applies to all HA products for members who are enrolled in Commercial FLEX products and select plans that have a cost-share component.

Learn more

To view the Notification for this medical policy, visit our Medical Policy Portal.





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