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Injectable hyaluronate acid products being removed from the Direct Ship Injectables Program

December 30, 2014

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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 Independence 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 Independence.

Providers who prescribe and administer hyaluronate acid products will receive a letter from Independence with more information.

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