Effective November 1, 2016, Harvard Pilgrim is updating its Hyaluronate Preparations for Osteoarthritis of the Knee Medical Review Criteria to include coverage for Hymovis (C9471). This new medication is indicated for the treatment of pain associated with osteoarthritis of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy or simple (non-opioid) analgesics and have a contraindication to Synvisc-One and Euflexa.
As a reminder, prior authorization is required for all hyaluronate preparations administered to members enrolled in Harvard Pilgrim commercial HMO, POS, and PPO products.
To request prior authorization, please fax a completed Hyaluronate Preparations for OA of Knee Prior Authorization Request form to 800-232-0816. For complete information, please see the updated Hyaluronate Preparations for Osteoarthritis of the Knee Medical Review Criteria.