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

March 2, 2015

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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 Euflexxa™, Gel-One®, Hyalgan®, Monovisc®, Orthovisc®, Supartz®, Synvisc®, and Synvisc-One™.

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.

Depending on the terms of the member's 2015 benefit contract, members may be subject to additional cost-sharing amounts for these drugs. Therefore, providers should discuss this change with their patients prior to April 1, 2015.

In January, letters were sent to physicians who prescribe and administer hyaluronate acid products to notify them of this change and to provide more information about the process for purchasing these drugs.

Clarification: As of January 1, 2015, precertification requirements were removed for Orthovisc®, Synvisc®, and Synvisc-One™, our three preferred products. The other five drugs in this class (Euflexxa™, Gel-One®, Hyalgan®, Monovisc®, and Supartz®) still require precertification from Independence. Providers who administer nonpreferred hyaluronate acid products without precertification approval will not be reimbursed. Providers who are currently ordering any hyaluronate acid product through the Direct Ship Injectables Program must continue to obtain authorization from Independence, regardless of whether the drug requires precertification. As a reminder, March 31, 2015, is the last day that hyaluronic acid products can be ordered through the Independence Direct Ship Injectables Program.

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