Hyaluronic acid derivatives coverage change effective Jan. 1
As of Jan. 1, 2017, hyaluronic acid derivatives will no longer be covered for the treatment of pain in osteoarthritis of the knee. This change affects commercial and Medicaid members only. It does not impact Medicare members. Evidence regarding effect on the quality of life, pain and function, and delay to total knee replacement surgery does not support this treatment as a cost effective therapy for osteoarthritis knee pain.
Priority Health continually strives to improve patient experiences and clinical outcomes while reducing the costs of diagnosis and treatment. The reviewed evidence was gathered from clinical practice guidelines by the American Academy of Orthopedic Surgeons, the American College of Rheumatology, and the Osteoarthritis Research Society International and technology assessments, the Agency for Healthcare Research and Quality, and Hayes, Inc.
Communicating this change
Members receiving these drugs during this change will be allowed to complete their treatment, but future treatment will not be covered. A letter will be mailed to each provider who prescribed hyaluronic acid injections in the past year informing them of this change.
For more information, review our hyaluronic acid derivatives page.