Hyaluronic Acid Intra-articular Products

Covers listed hyaluronic acid intra‑articular products only for the FDA‑approved indication of pain from osteoarthritis of the knee (other joints/non‑FDA uses excluded). Authorization requires radiographic confirmation of knee OA, failure of conservative therapy with at least two of three modalities (≥1 course PT; ≥2 pharmacologic agents from NSAIDs/acetaminophen/tramadol/duloxetine; ≥2 intra‑articular corticosteroid injections), administration by/under a rheumatology/orthopedics/physiatry specialist with product‑specific dosing, 6‑month approvals, and reauthorization requires prior clinical benefit and ≥6 months since the last hyaluronic acid injection.

"Treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and analgesics (FDA‑approved indication)."

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