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Sodium Hyaluronate Injection Update

Effective January 1, 2018, Horizon BCBSNJ will change the way that we approve and consider claims for certain sodium hyaluronate injections as noted below.

  1. Beginning with services to be provided on and after January 1, 2018, the following drugs will be included as part of our Medical Injectables Program (MIP):
    • Hyalgan
    • Supartz FX
    • Gel-Syn
    • GenVisc 850
    • Hymovis
    • Gel-One

    Magellan Rx Management will conduct medical necessity and appropriateness reviews (MNARs) for the above-noted sodium hyaluronate injections administered in an outpatient facility or a physician’s office.1

    Review the complete list of injectable medications that currently require MNAR as part of the MIP.

  1. Also, effective beginning January 1, 2018, based on our revised medical policy, Sodium Hyaluronate Injections, the criteria for coverage will require that members try one of the Preferred sodium hyaluronate injections (Euflexxa, Monovisc, Orthovisc, Synvisc or Synvisc-One) before receiving coverage for a non-Preferred sodium hyaluronate injection, unless there are specific medical circumstances that require the member use one of the non-Preferred sodium hyaluronate injections.2

    We encourage you to review this revised policy in our Medical Policy Manual.

If you have questions, please contact your Network Specialist.

1 MNAR is not required for injectable medications that are administered during an inpatient stay or in an Emergency Room setting.

2 MNAR is not required for Preferred sodium hyaluronate injections. Claims are medically necessary when sodium hyaluronate injections are used for osteoarthritis of the knee.
Magellan Rx Management is a service mark of Magellan Health, Inc.

This document contains prescription brand name drugs that are registered marks or trademarks of pharmaceutical manufacturers that are not affiliated with either Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association.


Work Smarter with Magellan Rx Management

Follow these best practices to save time when working with Magellan Rx Management:

  • Avoid delays in claim processing and reimbursement by always obtaining pre-service MNAR of injectable medications for your patients.
  • Avoid time spent waiting on the phone by submitting and managing your MNAR requests through Magellan Rx Management’s secure website, MagellanRx.com.

If you don’t already have a Magellan Rx Management username and password, we encourage you to request them today.

  • Visit MagellanRx.com.
  • Click the Provider Portal icon.
  • Click Prior Authorizations.
  • Click PA Medical Benefit.
  • Click New User Request Access (within the yellow Sign In section).
  • Click Contact Us.
  • Complete the required fields and then click Send.

Magellan will respond with a username, password and quick start guide within two business days.

Published on: September 29, 2017, 09:44 a.m. ET
Last updated on: April 2, 2018, 13:44 p.m. ET