Is Viscosupplementation Covered by Insurance?

July 3, 2024

Explore if viscosupplementation is covered by insurance, its effectiveness, and the future of treatment.

Understanding Viscosupplementation

Viscosupplementation is a medical procedure that has gained recognition in recent years. Particularly beneficial for patients with conditions like osteoarthritis, this treatment involves the injection of hyaluronic acid into affected joints. This section will delve into the definition, purpose, and mechanism of action of viscosupplementation.

Definition and Purpose

Viscosupplementation is a procedure that involves the injection of hyaluronic acid (HA) into affected joints. This treatment aims to restore the physiologic viscoelasticity in the synovial fluid in the absence of inflammation. The U.S. Food and Drug Administration approved this procedure in 1997, and it is available in several commercially prepared forms [2].

The primary purpose of viscosupplementation is to act as a lubricant and shock absorber for joint loads in patients with osteoarthritis. By restoring the natural properties of the synovial fluid, this treatment can help reduce pain and improve joint function. Furthermore, HA has been shown to downregulate pro-inflammatory factors and proteases known to break down the joint matrix.

Mechanism of Action

The mechanism of action of viscosupplementation revolves around the properties of hyaluronic acid. When injected into the joint, HA reduces cartilage breakdown that results from a loss of cartilage oligomeric matrix protein and also reduces inflammatory cytokines such as interleukin-1.

According to research, intra-articular injection of HA provides a moderate symptomatic benefit to knee OA patients and without major safety concerns. In fact, intra-articular HA may offer one of the best benefit/risk ratios among pharmacologic options, as measured by improvements in knee OA health outcomes, overall gain in quality adjusted life years, and substantial delays in time to total knee replacement (TKR).

Moreover, repeated courses of intra-articular HA injections have been shown to be an effective and safe treatment for knee OA [5]. Repeat courses maintain or further improve pain reduction while introducing no increased safety risk.

In conclusion, viscosupplementation offers significant therapeutic benefits for patients with osteoarthritis and similar conditions. As more research emerges, the understanding of this treatment's mechanism and its potential applications continues to expand.

Coverage of Viscosupplementation

Assessing the financial implications of medical procedures is a crucial part of the healthcare decision-making process. When it comes to viscosupplementation, the question of insurance coverage often arises. Let's delve into the specifics of private insurance coverage for viscosupplementation and the potential out-of-pocket expenses.

Private Insurance Coverage

Most private insurance or health benefits plans cover the cost of viscosupplement injections such as Synvisc and Neovisc. These are typically covered as "injections" or "devices," not as medications. Patients can request pseudo DIN numbers for these injections from their physician to check coverage with their insurance company.

Some insurers, like Blue Cross Blue Shield of Michigan, have previously considered discontinuing coverage for hyaluronic acid injections, also known as viscosupplementation therapy. However, they reversed their decision after reviewing additional information about the injections' effectiveness.

It's worth noting that coverage may vary among insurance providers. Therefore, patients are advised to contact their insurance providers to verify coverage for viscosupplementation procedures.

Out-of-Pocket Expenses

In cases where private insurance does not cover viscosupplementation, individuals may need to pay for the procedure as an out-of-pocket medical expense. If Blue Cross had discontinued coverage, for example, patients opting for knee joint lubricating shots would have had to pay around $450 to $1,000 out of pocket.

Comparatively, knee replacement surgeries, which are covered by private insurance and Medicare, can cost $28,000 or more, including physical therapy expenses. This illustrates the potential cost-saving benefits of viscosupplementation as an alternative to more invasive and costly procedures.

However, patients should discuss these costs with their healthcare provider and consider all factors, including the procedure's effectiveness and potential side effects, before opting for viscosupplementation.

Effectiveness of Viscosupplementation

Viscosupplementation is a therapy often utilized in the treatment of joint conditions. Its effectiveness, particularly in the context of osteoarthritis, has been a subject of interest for many researchers and medical professionals.

Treatment for Osteoarthritis

Viscosupplementation is most commonly used to treat symptoms of osteoarthritis of the knee. Osteoarthritis, a degenerative joint disease, often results in the breakdown of joint cartilage and the underlying bone. This condition often causes pain, swelling, and problems with joint movement. Viscosupplementation therapy aims to relieve these symptoms by restoring the normal properties of synovial fluid in the affected joint.

Research Findings

The effectiveness of viscosupplementation has been the subject of several studies. However, the results have been somewhat mixed.

For instance, the most recent research has not found viscosupplementation to be effective at significantly reducing pain or improving function. This finding has led some organizations, such as The Department of Veterans Affairs (VA) and The Department of Defense (DoD), to state that there is insufficient evidence to recommend for or against the use of intra-articular hyaluronate/hylan injection in patients with osteoarthritis of the knee.

On the other hand, there is research that suggests viscosupplementation (VS) is effective over placebo and more effective than NSAIDs and corticosteroids in pain reduction and improved functionality [1]. Despite current guidelines not recommending viscosupplementation for knee OA, there is an increasing body of evidence supporting its use over placebo and other types of injection therapy.

In light of these varying results, it's clear that further research is needed to conclusively determine the effectiveness of viscosupplementation in treating osteoarthritis. Patients considering this treatment method should consult with their healthcare provider to discuss potential benefits and risks.

Types of Hyaluronic Acid Preparations

Hyaluronic acid (HA) plays a crucial role in viscosupplementation, a treatment for osteoarthritis. It's important to understand the different types of HA preparations available for this procedure.

Synthetic Preparations

Several synthetic preparations of hyaluronic acid-based polymers have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of pain in osteoarthritis of the knee. These preparations are designed to mimic the properties of naturally occurring hyaluronic acid in the body, which acts as a lubricant and shock absorber for joint loads in patients with osteoarthritis.

These synthetic preparations are designed to reduce cartilage breakdown that results from a loss of cartilage oligomeric matrix protein and also reduces inflammatory cytokines such as interleukin-1.

Approved Options

Among the approved options for viscosupplementation are Sodium Hyaluronate preparations (Suparts Fx, Euflexxa, Gelsyn-3, Durolane, Hyalgen), single-use agents (Gel-One, Synvisc-One, Monovisc), and Hyaluronan (Orthovisc, Monovisc, Hymovic). These treatments have been shown to provide a moderate symptomatic benefit to knee osteoarthritis patients, with evidence supporting their efficacy and safety.

According to a study by Maheu et al. (2019), intra-articular HA may offer one of the best benefit/risk ratios among pharmacologic options, as measured by improvements in knee osteoarthritis health outcomes, overall gain in quality adjusted life years, and substantial delays in time to total knee replacement (TKR).

HA Preparations	Category
Suparts Fx, Euflexxa, Gelsyn-3, Durolane, Hyalgen	Sodium Hyaluronate Preparations
Gel-One, Synvisc-One, Monovisc	Single-Use Agents
Orthovisc, Monovisc, Hymovic	Hyaluronan

When considering viscosupplementation treatment, it's important to discuss the different HA preparations and options with your healthcare provider to determine the best treatment plan for your specific needs and condition.

Considerations for Viscosupplementation

Before proceeding with viscosupplementation, understanding patient eligibility and potential side effects is crucial to ensure the treatment's success and patient safety.

Patient Eligibility

Viscosupplementation therapy for the knee, involving intra-articular injections of hyaluronic preparations, is considered medically reasonable and necessary when specific conditions are met. According to CMS, candidates eligible for viscosupplementation are those with knee osteoarthritis who have failed to improve with other non-surgical treatments. Moreover, several synthetic preparations of hyaluronic acid-based polymers have been approved by the U.S. FDA for the treatment of pain in osteoarthritis of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics or NSAIDs.

However, the effectiveness of viscosupplementation is still under debate. According to the AAOS, the most recent research has not found viscosupplementation to be significantly effective in reducing pain or improving function for osteoarthritis of the knee. While some patients experience pain relief with the procedure, not all individuals benefit from these injections.

Potential Side Effects

Despite its potential benefits, viscosupplementation treatment is not without risks. Patients who undergo viscosupplementation may experience local reactions such as pain, warmth, and slight swelling immediately after the injection. These symptoms are usually short-lived, but they should be monitored closely to ensure they do not persist or worsen.

In rare cases, patients may develop an allergy-like reaction in the knee, characterized by redness, swelling, and pain. Such a reaction necessitates immediate medical attention to prevent further complications. As with any medical procedure, it is vital to discuss potential side effects with a healthcare provider before proceeding with viscosupplementation treatment [2].

By understanding the eligibility criteria and potential risks associated with viscosupplementation, patients can make informed decisions about their treatment options. It's always critical to have open discussions with healthcare providers to ensure the chosen path aligns with the patient's health status and treatment goals.

Future of Viscosupplementation

Viscosupplementation, as a treatment for osteoarthritis, is a field that's continuously evolving. Understanding the future of viscosupplementation involves examining ongoing research and potential long-term effects.

Ongoing Research

While viscosupplementation is most effective for early-stage arthritis (mild to moderate), further research is necessary to substantiate this claim [2]. Current studies aim to provide a more comprehensive understanding of viscosupplementation's long-term effects and effectiveness in treating arthritis.

Research has shown that intra-articular injection of hyaluronic acid (HA), a component of viscosupplementation, provides a moderate symptomatic benefit to knee OA patients without major safety concerns. As per a study by Maheu et al. (2019), HA potentially offers one of the best benefit/risk ratios among pharmacologic options, as evidenced by improvements in knee OA health outcomes, overall gain in quality-adjusted life years, and substantial delays in time to total knee replacement (TKR).

However, viscosupplementation's effectiveness varies among patients. Some research suggests that not all individuals benefit from these injections and viscosupplementation may not significantly reduce pain or improve function. Ongoing research endeavors to explain these variances and optimize the treatment protocol.

Long-Term Effects

Insights into the long-term effects of viscosupplementation are primarily derived from studies focusing on repeat courses of intra-articular HA injections. A study by Altman et al. (2018) has shown that repeat courses are an effective and safe treatment for knee OA. These repeated courses were found to maintain or further improve pain reduction without increasing safety risks.

However, the long-term effects of viscosupplementation are still under investigation. As research continues, more comprehensive data will allow for a more nuanced understanding of the long-term implications of this treatment, contributing to the ongoing discourse on its coverage by insurance.

The future of viscosupplementation depends on the outcomes of ongoing research and its implications for patient care. By continuously studying this treatment, researchers hope to broaden its implementation, improve its effectiveness, and ensure its safety for patients with osteoarthritis. These advancements will significantly impact the question, "is viscosupplementation covered by insurance?" as insurers will need to adapt their coverage policies to reflect the progress in this field.