Formulary guidance and transparency from P&T to point of care

MMIT Reality Check on Viscosupplements

Posted by Matt Breese on Jan 8, 2016

Find me on:

Key insights and data direct from health plans reveals the following market access analysis of viscosupplements in our most recent Reality Check. For the full piece piece, click here.

Payer Coverage: Reimbursement restrictions permeate the viscosupplement drug landscape. Products covered under a payer's medical benefit face prior authorizations or step therapies for roughly 70% of covered lives. 


Source: MMIT data as of Q1 2016

Trends: Contrary to the lack of support from organizations like the American Academy of Orthopaedic Surgeons, the majority of physicians favor the utilization of viscosupplementation to relieve pain for patients. Recent clinical trials provide evidence for more effective long-term viscosupplement treatments in patients with osteoarthritis of the knee.

Key Findings: The combination of pharmacy and medical benefit coverage drives increasing market access complexity for viscosupplements. Top payers cover viscosupplements for less than half of pharmacy benefit lives. While the medical benefit landscape contains more favorable statuses, many payers implement utilization management policies. Several treatment options exist for patients with osteoarthritis of the knee. Viscosupplements compete with agents within the immediate class, as well as surgery options and other alternative therapies, based on the patient's situation.

In the full Reality Check on viscosupplements below, MMIT's team of experts takes a deeper look into the clinical characteristics, drug market access and payer coverage to summarize key findings within the class.

View Reality Check

Topics: Market Access