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Surgeons seek coverage of viscosupplementation by insurance companies
KOLOA, Hawaii — Millions of patients with meniscal and other soft tissue injuries of the knee who might be candidates for viscosupplementation are unable to receive this treatment because some insurance carriers no longer cover it for this indication, presenters at a panel discussion at Orthopedics Today Hawaii, here, said.
The good news, according to a presenter, is efforts now underway by concerned orthopedic surgeons seek to change the mind of decision-makers at the American Academy of Orthopaedic Surgeons regarding the organization’s position on the indication for viscosupplementation, which has influenced insurance carriers.
In discussing his preferred treatment for a 40-year-old patient with knee osteoarthritis who underwent debridement but continued to have pain in the absence of mechanical symptom or effusion, William R. Beach, MD, said, “Unless they are going to buy it themselves, you cannot get viscosupplementation in Richmond, Virginia, if you have got Anthem. So, that is out. [Platelet-rich plasma] is actually cheaper.”
Jack M. Bert, MD, who moderated the session, explained further.
“Just for those of you who are still using viscosupplementation, I realize in 35 states with [Blue Cross Blue Shield], you cannot do it. Now, with Anthem, it is another 42 million patients in whom you cannot use it,” Bert said.
The AAOS noted, however, in its 2016 publication by Herman Johal, MD, and his colleagues that high molecular-weight compounds of hyaluronic acid for intra-articular injection are “effective in improving symptoms in patients with mild to moderate OA,” according to Bert.
The three viscosupplementation products used in the United States are all considered high molecular-weight, which means the product has greater than 3 million Da, Bert said. “They all approximate 6 million Da, which is the normal molecular-weight of a patient with synovial fluid that is about 16 to 18 years old.”
Regarding discussions underway with the AAOS about coverage for viscosupplementation, “We are doing everything we can to change the academy’s mind on this. We think we might have a pretty good chance by April of getting them to approve high molecular-weight ‘visco.’ We will know that probably in about 3 months,” Bert said. – by Susan M. Rapp
Reference:
Bert JM. Articular cartilage: knee injectables. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Johal H, et al. JBJS Rev. 2016;doi:10.2106/JBJS.RVW.15.00098.
Disclosure: Bert reports he is a consultant for Sanofi and is a speaker and consultant for Flexion Therapeutics Inc.