In several U.S. states, Blue Cross/Blue Shield and other insurers have dropped or are considering dropping coverage of hyaluronic acid injection—or viscosupplementation—for patients with knee osteoarthritis. The decision appears to be based on guidelines published by the American Academy of Orthopaedic Surgeons in 2013, which at that time specified that research had not found hyaluronic acid injection “effective at significantly reducing pain or improving function.”1
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However, Charles Degenhardt III, MD, a rheumatologist based in Savannah, Ga., says the guidelines were never intended to serve as the basis for coverage determination.
David Jevsevar, MD, MBA, chair of the AAOS Council on Research and Quality, told Medscape in 2013: “Even though we say in the guidelines that we don’t want the guidelines used for coverage-based determinations, our fear is that payers will do that.”6