Does Medicare Cover Orthovisc Injections?

In this article...
  • Does Medicare cover Orthovisc? Discover whether Orthovisc is covered by Medicare and Medicare Advantage Plans and how much Orthovisc costs without insurance.

Knee arthritis is a painful condition that can cause mobility problems. Many people with knee arthritis get relief from an injectable lubricant like Orthovisc. But does Medicare cover Orthovisc? Below, you can find out whether Original Medicare and Medicare Advantage cover Orthovisc. 

Does Medicare Cover Orthovisc Injections?

Original Medicare (Parts A and B) doesn't cover Orthovisc injections. Unfortunately, beneficiaries with Part D coverage through a private insurer aren't covered for Orthovisc injections either. However, Part D coverage may cover other alternative drugs to treat joint pain and lubricate the joints. Beneficiaries can consult their physicians to find a suitable treatment for their condition that qualifies for Part D coverage. 

Does Medicare Advantage Cover Orthovisc Injections?

Whether Medicare Advantage Plans cover Orthovisc injections depends on which private insurer you use. Medicare Advantage Plans are available through third-party companies approved by Medicare. Those incorporating drugs coverage may cover a wider range of medications than a standard Part D add-on plan. 

You can check if your insurer covers Orthovisc injections by checking the company's medication formulary, a list of funded medications. Most insurers will require that the treatment is medically necessary and that there is no more conservative treatment that could produce similar relief before agreeing to pay for Orthovisc injections. 

How Much Does a Shot of Orthovisc Cost?

If you want to use Orthovisc injections to treat your condition and your doctor agrees, you will need to fund your treatment out of pocket unless you have private health insurance that covers Orthovisc. 

The cost of Orthovisc injections will vary depending on which provider and doctor you use. Generally, you should expect to pay between $550 and $1,300 for three 2-milliliter shots.  

How Do Orthovisc Injections Work?

Orthovisc injections contain purified hyaluronan, a chemical that occurs naturally in the joints. Hyaluronan acts as a joint lubricant and reduces the impact of shocks on the joint, allowing optimal movement. Certain conditions, such as osteoarthritis, can reduce the amount of hyaluronan naturally present in the joints, causing and exacerbating joint pain. 

A licensed doctor can inject Orthovisc into the affected joint to replenish hyaluronan levels and improve pain and mobility. The treatment is generally recommended for people who haven't experienced adequate pain relief using painkillers and physical therapy. Clinical trials show that Orthovisc is an effective treatment for knee pain caused by osteoarthritis, and it can relieve pain for up to 6 months following treatment. You should avoid straining the knee joint for at least 48 hours after the injection.

What Are the Risks of Orthovisc Injections?

The most common side effects of Orthovisc injections are pain, aching and swelling around the injection site. Some people also develop a localized skin reaction, such as hives or an itchy rash. Generally, side effects are mild and resolve within a few days. If you develop severe or persistent side effects, you should seek prompt medical attention. You should tell your doctor beforehand if you have an infection or are pregnant or breastfeeding because Orthovisc may not be suitable for you. 

Another potential risk of using Orthovisc injections is an allergic reaction. You shouldn't use Orthovisc if you're allergic to bird products because it contains hyaluronan harvested from rooster combs. 

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