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New medical policy criteria for commercial members in treatment for osteoarthritis of the knee

June 1, 2015

Currently, there are eight hyaluronic acid products that have been approved by the U.S. Food and Drug Administration to treat osteoarthritis of the knee: Euflexxa®, Gel-One®, Hyalgan®, Monovisc®, Orthovisc®, Supartz®, Synvisc®, and Synvisc-One®. These products have demonstrated equivalent therapeutic results when used for this indication.

Effective September 1, 2015, our commercial medical policy on these drugs will be updated. All eight hyaluronic acid products will continue to be eligible for coverage, but the criteria for using the designated preferred and nonpreferred products will change.

We ask that you familiarize yourself with the new version of this policy, which will be available after June 3, 2015, in the Policy Notifications section of our Medical Policy Portal. Select Accept and Go to Medical Policy Online, then in the Policy Notifications section, select Commercial and type the policy number or title in the Search box: #11.14.07m: Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis.

In accordance with the criteria listed in our commercial policy, Orthovisc®, Synvisc®, and Synvisc-One® will continue to be Independence?s preferred hyaluronic acid products for the treatment of osteoarthritis of the knee.


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