Coverage, access, and reimbursement will vary by state as well as by the patient’s Medicaid eligibility status, so it is important to verify a patient’s Medicaid program benefits for Synvisc-One^® and SYNVISC^® (hylan G-F 20).

In addition, you should confirm whether Medicaid patients have other forms of insurance. Medicaid is the payer of last resort, so in cases where patients have Medicare or other types of supplemental commercial insurance, Medicaid always pays secondary or tertiary to these payers.

State Medicaid programs cover drugs under the medical and/or pharmacy benefit(s). Physician-administered products, like Synvisc-One and SYNVISC, generally are covered under the medical benefit.

Some states, however, may manage drug coverage and reimbursement through the pharmacy benefit. In these cases, patients obtain the drug at a pharmacy and bring it to the physician’s office for administration. In addition to confirming a patient’s eligibility and benefits under Medicaid, it is important to confirm under what guidelines Synvisc-One and SYNVISC should be obtained. For example, some states may place quantity restrictions on the number of prescriptions filled per month, some may require that patients obtain the product through specific retail pharmacies, and others may require PA.

Providers retain responsibility for determining reimbursement and insurance issues related to their patients. Genzyme cannot be responsible for failure of a provider to obtain reimbursement.