As previously communicated in a
Partners in Health UpdateSM article, as of January 1, 2020, our medical policies on hyaluronate acid (HA) products reflect new coverage criteria, which better align 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®
no longer requires precertification for Independence members.
The following policies are
effective as of 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 sixteen 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 HA 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 these policies, visit our
Medical Policy Portal.