[
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.
]