Starting Jan. 1, 2020, we'll cover select hyaluronic acid products

Effective Jan. 1, 2020, Blue Cross Blue Shield of Michigan and Blue Care Network will consider the following hyaluronic acid products to be either covered or preferred under the medical benefit:

  • Durolane®
  • Euflexxa®
  • Gelsyn-3™
  • Supartz FX™

Starting Jan. 1, we'll consider the following to be either noncovered or nonpreferred hyaluronic acid products: Gel-one®, GenVisc 850®, Hyalgan®, Hymovis®, Monovisc®, Orthovisc®, Synvisc®, Synvisc-One®, TriVisc®, Visco-3™, Synojoynt™ and Triluron™.

This change will apply to Blue Cross' PPO (commercial), Medicare Plus BlueSM PPO, BCN HMOSM (commercial) and BCN AdvantageSM members. This change won't apply to self-funded General Motors, Fiat Chrysler Automobiles, Ford Motor Company, and UAW Retiree Medical Benefit Trust commercial groups.

Blue Cross' PPO and BCN HMO commercial members

  • Members who began receiving noncovered hyaluronic acid products prior to Jan. 1, 2020, can continue their treatment courses to completion. For future treatment courses that begin on or after Jan. 1, 2020, we encourage providers to talk to their patients about using a covered hyaluronic acid product.
  • For treatment courses that begin on or after Jan. 1, 2020, we'll require members to use a covered hyaluronic acid product; these products don't require authorization.
  • We'll deny claims for noncovered hyaluronic acid drugs.
  • We'll notify affected members of these changes and encourage them to discuss treatment options with you.

Medicare Plus Blue and BCN Advantage members

  • Members who began receiving nonpreferred hyaluronic acid products prior to Jan. 1, 2020, can continue their treatment courses to completion. For future treatment courses that begin on or after Jan. 1, 2020, we encourage providers to talk to their patients about using a preferred hyaluronic acid product.
  • For treatments on or after Jan. 1, 2020, we'll require members to use preferred hyaluronic acid products; these products won't require authorization. If you select a nonpreferred hyaluronic acid product for a member, you will have to obtain authorization.

Additional information

The U.S. Food and Drug Administration has approved 16 hyaluronic acid products. To date, no study has shown that one hyaluronic acid product is superior to others.

Posted: September 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network