Medicaid Insurance Reimbursement
Synvisc-One® and SYNVISC® Medicaid coverage
Coverage, access, and reimbursement will vary by state as well as by the patient's Medicaid eligibility status, so it is important to verify a patient's Medicaid program benefits for Synvisc-One® and SYNVISC®.
In addition, you should confirm whether Medicaid patients have other forms of insurance. Medicaid is the payer of last resort, so in cases where patients have Medicare or other types of supplemental commercial insurance, Medicaid always pays secondary or tertiary to these payers.
State Medicaid programs cover drugs under the medical and/or pharmacy benefit(s). Physician-administered products, like Synvisc-One and SYNVISC, generally are covered under the medical benefit.
Some states, however, may manage drug coverage and reimbursement through the pharmacy benefit. In these cases, patients obtain the drug at a pharmacy and bring it to the physician's office for administration. In addition to confirming a patient's eligibility and benefits under Medicaid, it is important to confirm under what guidelines Synvisc-One and SYNVISC should be obtained. For example, some states may place quantity restrictions on the number of prescriptions filled per month, some may require that patients obtain the product through specific retail pharmacies, and others may require PA.
Synvisc-One and SYNVISC Medicaid reimbursement
States mandate their individual drug reimbursement methods. While methods vary, state Medicaid agencies usually pay for products administered in the office and hospital outpatient settings based on AWP or ASP. Medicaid payment policies for Synvisc-One and SYNVISC administration and associated office visits typically are similar to those under Medicare, with reimbursement structured according to a physician fee schedule.
Providers retain sole responsibility for determining reimbursement and insurance issues related to their patients and for ensuring the accuracy of their submission claims. Sanofi cannot be responsible for failure of a provider to obtain reimbursement.
SYNVISC® (hylan G-F 20) and Synvisc-One® (hylan G-F 20) are indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and simple analgesics, e.g., acetaminophen.
IMPORTANT SAFETY INFORMATION
IMPORTANT SAFETY INFORMATION
SYNVISC and Synvisc-One are contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the target knee. Hypersensitivity reactions including anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and angioedema have been reported for both SYNVISC and Synvisc-One.
Do not concomitantly use disinfectants containing quaternary ammonium salts for skin preparation because hyaluronan can precipitate in their presence. Do not inject SYNVISC or Synvisc-One extraarticularly, into the synovial tissues, into the fat pad or joint capsule, or intravascularly.
The safety and efficacy of Synvisc-One in locations other than the knee, or for conditions other than osteoarthritis, or in combination with other intra-articular injectables, or in severely inflamed knee joints have not been established. Use caution when injecting SYNVISC or Synvisc-One in patients allergic to avian proteins, feathers, or egg products; who have evidence of lymphatic or venous stasis in the leg to be treated; or who have severe inflammation in the knee to be treated. Remove any synovial fluid or effusion before injecting SYNVISC or Synvisc-One. Strict adherence to aseptic technique must be followed to avoid joint infection. The safety and effectiveness of SYNVISC and Synvisc-One have not been established in children (≤21 years old) or in pregnant or lactating women. Patients should be advised to avoid strenuous or prolonged weight-bearing activities for approximately 48 hours after treatment.
In clinical trials, the most commonly reported adverse events were transient pain, swelling, and or joint effusion in the injected knee. The following reported adverse events are among those that may occur in association with intra-articular injections, including Synvisc: arthralgia, joint stiffness, joint effusion, joint swelling, joint warmth, injection site pain, arthritis, arthropathy, and gait disturbance.
The most commonly reported adverse events were arthralgia, arthritis, arthropathy, injection site pain, and joint effusion. The following reported adverse events are among those that may occur in association with intra-articular injections, including Synvisc-One: arthralgia, joint stiffness, joint effusion, joint swelling, joint warmth, injection site pain, arthritis, arthropathy, and gait disturbance.