Reimbursement – Hyalgan for Healthcare Professionals

This convenient program includes insurance benefit investigation and prior authorization support, access to the HYALGAN^® patient assistance program, and timely status updates.

Complete support for your office to prescribe HYALGAN^® with confidence

Quick Turnaround (2 business days or less)

Patient-specific Benefits Investigation

Prior Authorization Applications and Renewals

Appeals Assistance

Specialty Pharmacy Triage

Real-time enrollment status updates

Allows for maximized visibility and the insight necessary to track a referral’s journey throughout the fulfillment process.

Support hotline 1-866-749-2542, Option 2

Reimbursement support
Physician support services

Available Monday-Friday, 9 AM to 8 PM ET
Fax: 1-877-447-9734
For patient insurance verification, register/login to: www.fidiacomplete.com

Access necessary resources for reimbursement

HYALGAN^® Reimbursement Guide

Fidia Complete HCP Reimbursement Portal

Letter of Medical Necessity

Coding in the Hospital Outpatient Setting

CMS 1500 Sample Claim Form

Sample Letter of Appeal

Benefits Investigation and Patient Assistance Enrollment Form

Prior Authorization Checklist

Coding in the Physician Office Setting

CMS 1450 Sample Claim Form

Denied Claims and Appeals Checklist

2021 Poverty Guidelines

Fidia Complete Portal Registration Information

The HYALGAN^® Patient Assistance Program (PAP)

Patients who meet the eligibility criteria may receive HYALGAN^® at no charge. In order for a patient to be eligible for the HYALGAN^® PAP, she or he must meet the following eligibility criteria:

They must be a legal US resident
They must have an annual income at or below 250% of the Federal Poverty Line
They must not have any public or private prescription drug insurance

2021 Poverty Guidelines^a

^aSOURCE: https://aspe.hhs.gov/poverty-guidelines
The typical turnaround time for an application related to Reimbursement or PAP is less than 48 hours. If the patient is approved for Patient Assistance, the product then ships via FedEx 2-day to the physician’s office.

Indication

HYALGAN^® 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 to simple analgesics, eg, acetaminophen.

Important Safety Information

HYALGAN^® is contraindicated in patients with known hypersensitivity to hyaluronate preparations. Intra-articular injections are contraindicated in cases of present infections or skin diseases in the area of the injection site to reduce the potential for developing septic arthritis.

Transient increases in inflammation in the injected knee following HYALGAN^® injection have been reported in some patients with inflammatory arthritis such as rheumatoid arthritis or gouty arthritis. Physicians should evaluate whether HYALGAN^® treatment should be initiated when objective signs of inflammation are present.

The effectiveness of a single treatment cycle of less than 3 injections has not been established.

Patients should be advised to avoid any strenuous or prolonged weight-bearing activities within 48 hours following intra-articular injection.

Use caution when injecting HYALGAN^® into patients who are allergic to avian proteins, feathers, and egg products.

Joint effusion, if present, should be removed prior to injection.

The safety and effectiveness of HYALGAN^® has not been established in children or in pregnant or lactating women. It is unknown whether HYALGAN^® is excreted in human milk.

In the US clinical trial of 495 patients, the only adverse event showing statistical significance vs placebo was injection-site pain. Other adverse events included gastrointestinal complaints, headache, local ecchymosis and rash, local joint pain and swelling, and local pruritus. However, the incidence of these events was similar in the HYALGAN^®-treated and placebo groups. In other clinical studies, the frequency and severity of adverse events occurring during the repeat treatment cycles did not increase over that reported for a single treatment cycle.

Please see package insert for full prescribing information including indications, contraindications, warnings, precautions, and adverse events.

Rx Only.

Please see Full Prescribing Information.

The most trusted HA treatment worldwide

This convenient program includes insurance benefit investigation and prior authorization support, access to the HYALGAN® patient assistance program, and timely status updates.

Complete support for your office to prescribe HYALGAN® with confidence

Real-time enrollment status updates

Support hotline 1-866-749-2542, Option 2

Access necessary resources for reimbursement

The HYALGAN® Patient Assistance Program (PAP)

2021 Poverty Guidelinesa

References

STUDY SUMMARY: ALTMAN, 1998

Intra-articular sodium hyaluronate (HYALGAN®) in the treatment of patients with osteoarthritis of the knee: A randomized clinical trial2

Study design

Results

STUDY SUMMARY: SCALI, 1995

Intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee: A long-term study3

Study design

Results

STUDY SUMMARY: NEUSTADT, 2003

Long-term efficacy and safety of intra-articular sodium hyaluronate (HYALGAN®) in patients with osteoarthritis of the knee4

Study design

Results

This convenient program includes insurance benefit investigation and prior authorization support, access to the HYALGAN^® patient assistance program, and timely status updates.

Complete support for your office to prescribe HYALGAN^® with confidence

The HYALGAN^® Patient Assistance Program (PAP)

2021 Poverty Guidelines^a

Intra-articular sodium hyaluronate (HYALGAN^®) in the treatment of patients with osteoarthritis of the knee: A randomized clinical trial²

Intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee: A long-term study³

Long-term efficacy and safety of intra-articular sodium hyaluronate (HYALGAN^®) in patients with osteoarthritis of the knee⁴