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New policy criteria for treatment of osteoarthritis of the knee

October 3, 2019

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.


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