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Effective April 1, 2015, injectable hyaluronate acid products to
treat osteoarthritis of the knee will no longer be available through the
AmeriHealth Direct Ship Injectables Program. The drugs that are included with
this change are EuflexxaTM, Gel-One®,
Hyalgan®, Monovisc®, Orthovisc®,
Supartz®, Synvisc®, and
Synvisc-OneTM.
These eight drugs will continue to be covered under the medical benefit for
members who meet the medical necessity criteria listed in the applicable
medical policy:
- Commercial:
#11.14.07l: Intra-Articular Injection of Hyaluronan for
the Treatment of Osteoarthritis;
- Medicare Advantage:
#MA11.023: Hyaluronan Acid Therapies for
Osteoarthritis of the Knee.
How this change affects providers
Providers who prescribe hyaluronate acid products will need to purchase
these drugs from the manufacturer or a specialty pharmacy vendor and stock them
in their office. In order to receive reimbursement for the cost of the
pharmaceutical, the provider will need to submit a claim to AmeriHealth.
Providers who prescribe and administer hyaluronate acid products will
receive a letter from AmeriHealth with more information.
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