Effective January 1, 2020, our medical policies on
hyaluronate acid (HA) products will reflect new coverage criteria, which will
provide more alignment with our Commercial and Medicare Advantage policies.
This includes 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
Independence members.
The following policies were posted as Notifications on October 3, 2019, and
will go into effect January 1, 2020:
- Commercial: #11.14.07u: Intra-Articular Injection of
Hyaluronan for the Treatment of Osteoarthritis
- Medicare Advantage: #MA11.023i: Hyaluronan Acid Therapies
for Osteoarthritis of the Knee
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 policies.
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. To access a list of specialty drugs
with cost-sharing, please visit our website.
Learn more
To view the Notifications for these policies, visit our Medical Policy
Portal.