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SYNVISC

Medicaid

Most state Medicaid programs will cover SYNVISC® for FDA-approved indications. However, since each state's Medicaid agency determines its own coverage and reimbursement policies, it's important to understand your patients' eligibility and benefits. Remember, Medicaid is the payer of last resort, so coverage is provided only after all other insurance has been exhausted.

Be sure to check your state-specific guidelines for answers to these important questions about coverage:

Is SYNVISC covered as a medical benefit or a pharmacy benefit?
Some states may require patients to obtain SYNVISC at a pharmacy and bring it to your office for in-office administration. Other states may cover SYNVISC as acquired and billed in the office under the medical benefit.

For billing instructions in the office setting:
Download the Sample CMS-1500 Claim Form (PDF, 225K).

Download more Forms & Sample Letters including a Blank CMS-1500 Claim Form (PDF, 87K).

Are there any quantity restrictions?
Some states impose dosage limitations or monthly prescription caps under patient-specific Medicaid benefits. Be sure to verify your patient's eligibility for Medicaid coverage and his or her specific plan benefits for SYNVISC.

Is prior authorization required?
If so, SYNVISC ConnectionSM can help to determine prior authorization requirements.

Questions about Medicaid coverage?
Call SYNVISC Connection at 1-800-982-8292, M-F, 9 am -6 pm (EST).




Important Safety Information

SYNVISC® (hylan G-F 20) is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and simple analgesics, e.g., acetaminophen. In clinical trials, the most commonly reported adverse events were transient local pain, swelling, and/or effusion in the injected knee. In some cases, these symptoms have been extensive. Other side effects such as rash have been reported rarely.

SYNVISC is contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the knee. Use caution when using SYNVISC in patients allergic to avian proteins, feathers, or egg products; who have evidence of venous or lymphatic stasis in the leg to be treated; or who have severe inflammation in the knee joint to be treated. Patients should be advised to avoid strenuous or prolonged weight-bearing activities after treatment. Strict adherence to aseptic technique must be followed to avoid joint infection. The safety and effectiveness of SYNVISC in children and in pregnant or lactating women have not been established. It is unknown whether SYNVISC is excreted in human milk.

View the Complete Prescribing Information for SYNVISC (PDF, 146k)