Orthovisc® Medicare Coverage

Orthovisc®
Chemical name: Hyaluronate

Typical dosage: 15mg/ml

Typical type: Injection1

Orthovisc® is a medication typically used to treat pain due to osteoarthritis of the knee. It is a brand name only medication and is available as an injection into the joint (intra-articular).

Orthovisc is a prescription medication that contains the active ingredient hyaluronate. Orthovisc is injected once weekly intra-articularly (into the joint) for a total of 3 or 4 doses.

Orthovisc works as a lubricant and shock absorber in the joints to help the joints work properly.

The major side effects of Orthovisc include injection irritation, mild pain, stiffness or warmth in or by the knee, back pain and muscle pain.

Does Medicare cover Orthovisc?

No. Medicare Advantage plans and Medicare Part D plans do not typically cover Orthovisc.1

You may be able to find Medicare Advantage plans or Part D plans that cover other drugs that help treat osteoarthritis pain.

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability.

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Average costs for Orthovisc with Medicare drug coverage1

Because Medicare Advantage plans and Medicare Part D plans do not typically cover Orthovisc, you will likely be responsible for all costs for this drug if you have one of these types of Medicare coverage.

Additional information

Avoid activity for 48 hours after receiving an Orthovisc injection (or as long as you have been advised by a doctor). Do not stand on your feet for more than 1 hour at a time during the first 48 hours after getting this drug.

You should call your doctor if you experience severe knee pain, knee swelling or irritation where the drug is used.

You may not be able to get Orthovisc if you have a current or recent knee joint infection or infection at the site of injection.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Orthovisc. Retrieved May 2019, from www.goodrx.com/orthovisc.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.