Hyalgan® Medicare Coverage

Hyalgan is a prescription medication usually injected into the knee and should only be administered by an experienced healthcare provider who has appropriate training, experience and knowledge of proper injection technique.

Hyalgan is classified as a viscusupplement and contains the active ingredient Hyaluronate. Hyalgan is injected once weekly for 5 weeks for a total of 5 injections. Some patients may benefit with a total of 3 injections.

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

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

How much does Hyalgan cost with Medicare?

If Medicare Part B covers Hyalgan treatments for you because you meet the qualifying conditions, you’ll typically pay 0% to 20% of the Medicare-approved amount for the Hyalgan prescription price, after you meet your Part B deductible.

In 2024, the Medicare Part B deductible is $240 per year. Once you pay this amount, you’ll pay the remaining copay costs Medicare Part B doesn’t cover.

Does Medicare cover Hyalgan?

Medicare Part B covers injectable and infused drugs administered by a medical provider for qualified beneficiaries.

You don’t need a Medicare Advantage plan or a Medicare Part D prescription drug plan to get Hyalgan coverage.¹

If you have either type of private drug plan, you’re enrolled in Medicare Part B, and you qualify for Medicare coverage of Hyalgan, your Part B benefits will cover Hyalgan.

Some Medicare Advantage plans and Medicare Part D plans cover other prescription drugs that aren’t administered in a doctor’s office or by a medical professional.

• Part D plans or Medicare Advantage plans that cover drugs include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2024 Medicare Advantage plans include prescription drug coverage.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. You may be able to find Medicare Advantage plan options in your area that cover prescription drugs. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

Additional information

Hyalgan is used in patients with osteoarthritis of the knee who have pain that is not responding to non-medication treatment and simple pain medications like ibuprofen.

Avoid activity for 48 hours after receiving an Hyalgan 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 Hyalgan 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.