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Injectable hyaluronate acid products removed from the Direct Ship Drug Program

August 31, 2016

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As a reminder, injectable hyaluronate acid products to treat osteoarthritis of the knee are no longer available through the Independence Direct Ship Drug Program. This includes EuflexxaTM, Gel-One®, Gel-SynTM, GenVisc 850®, Hyalgan®, Hymovis®, Monovisc®, Orthovisc®, Supartz®, Synvisc®, Synvisc-OneTM, and VISCO-3TM, as well as any new hyaluronate acid product that receives approval from the U.S. Food and Drug Administration (FDA).

These 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: #11.14.07o: Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
  • Medicare Advantage: #MA11.023c: Hyaluronan Acid Therapies for Osteoarthritis of the Knee
To view these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select the Commercial or Medicare Advantage tab from the top of the page, depending on the version of the policy you would like to view. Then type the policy name or number in the Search field.

How this change affects providers

Providers who prescribe hyaluronate acid products must 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.

In January 2015, 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.

Precertification requirements

Also in January 2015, precertification requirements were removed for Orthovisc®, Synvisc®, and Synvisc-OneTM, our three preferred products. All other drugs in this class including, but not limited to, EuflexxaTM, Gel-One®, Gel-SynTM, GenVisc 850®, Hyalgan®, Hymovis®, Monovisc®, Supartz®, and VISCO-3TM still require precertification from Independence. Providers who administer nonpreferred hyaluronate acid products without precertification approval will not be reimbursed.

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