SYNVISC® (HYLAN G-F 20) & SYNVISC-ONE® (HYLAN G-F 20)

SYNVISC and SYNVISC-ONE are covered by many commercial payers; however, you should be aware of patient-specific insurance benefits and plan restrictions.

Before treating a patient with SYNVISC or SYNVISC-ONE, it is recommended that you conduct an insurance verification to understand patient-specific insurance coverage. This will help to assess if SYNVISC and SYNVISC-ONE are covered, whether there is a specialty pharmacy option, whether there are setting-of-care restrictions, and what the patient's cost-sharing requirements, including deductibles, co-payments, co-insurance, and out-of-pocket maximums are.

If your patient needs assistance in affording SYNVISC or SYNVISC-ONE, Sanofi Patient Connection^® could potentially help. Click here to learn more.

SYNVISC and SYNVISC-ONE commercial payer reimbursement

Under commercial payers, reimbursement for SYNVISC, SYNVISC-ONE and the associated administration will vary, based on the contract established between the provider and payer.
Reimbursement for injectable products is generally based on average wholesale price (AWP), wholesale acquisition cost (WAC), or average sales price (ASP), plus or minus a contracted percentage.
In some instances under managed care, providers are capitated for all the costs of care, including injectable medications. They may receive a monthly per member per month (PMPM) payment and no additional reimbursement for specific services rendered. Alternatively, some commercial payers may require physicians to obtain SYNVISC and SYNVISC-ONE through specialty pharmacies. In these cases, physicians neither bill nor receive payment for the product; rather, payers reimburse the specialty pharmacies directly for the product and physicians need only bill for their professional services.
Using a specialty pharmacy allows you to focus on patient care by potentially limiting the financial risk that carrying inventory for your commercial patients can pose.

Find Prior Authorization Form

In the hospital outpatient setting, commercial payers typically reimburse for SYNVISC or SYNVISC-ONE, based on a contracted AWP-, WAC-, or ASP-based amount, plus or minus a certain percentage. Reimbursement for hospital administration services may be determined according to a prospectively set payment rate, similar to the OPPS APC system. Alternatively, payment may be based on case rate or other type of negotiated fee schedule.

Find Prior Authorization Form

Providers retain sole responsibility for determining reimbursement and insurance issues related to their patients and for ensuring the accuracy of their submission claims. Sanofi cannot be responsible for failure of a provider to obtain reimbursement.

Specialty Pharmacy Forms

Find prior authorization and other carrier-specific forms required for ordering.

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Educational Resources for Your Patients

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Important Safety Information

SYNVISC and SYNVISC-ONE are contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the target knee. Hypersensitivity reactions including anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and angioedema have been reported for both SYNVISC and SYNVISC-ONE.

Do not concomitantly use disinfectants containing quaternary ammonium salts for skin preparation because hyaluronan can precipitate in their presence. Do not inject SYNVISC or SYNVISC-ONE extra-articularly, into the synovial tissues, into the fat pad or joint capsule, or intravascularly. Some cases of skin necrosis have been reported after intra-articular use of hyaluronic acid. Patients should be instructed to contact their treating physician if signs of skin disorder (such as change of color or open sores) appear. SYNVISC and SYNVISC-ONE are only intended for use by a healthcare professional adequately trained to administer intra-articular injections, according to standard medical practices.

The safety and efficacy of SYNVISC or SYNVISC-ONE in locations other than the knee, or for conditions other than osteoarthritis, or in combination with other intra-articular injectables, or in severely inflamed knee joints have not been established. Use caution when injecting SYNVISC or SYNVISC-ONE in patients allergic to avian proteins, feathers, or egg products; who have evidence of lymphatic or venous stasis in the leg to be treated; or who have severe inflammation in the knee to be treated. Remove any synovial fluid or effusion before injecting SYNVISC or SYNVISC-ONE. Strict adherence to aseptic technique must be followed to avoid joint infection. The safety and effectiveness of SYNVISC and SYNVISC-ONE have not been established in children (≤21 years old) or in pregnant or lactating women. Patients should be advised to avoid strenuous or prolonged weight-bearing activities for approximately 48 hours after treatment.

Indication

SYNVISC^® (hylan G-F 20) and SYNVISC-ONE^® (hylan G-F 20) are 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 simple analgesics, e.g., acetaminophen.

For SYNVISC

In clinical trials, the most commonly reported adverse events were transient pain, swelling, and/or joint effusion in the injected knee. The following reported adverse events are among those that may occur in association with intra-articular injections, including SYNVISC: arthralgia, joint stiffness, joint effusion, joint swelling, joint warmth, injection site pain, arthritis, arthropathy, and gait disturbance.

For SYNVISC-ONE

The most commonly reported adverse events were arthralgia, arthritis, arthropathy, injection site pain, and joint effusion. The following reported adverse events are among those that may occur in association with intra-articular injections, including SYNVISC-ONE: arthralgia, joint stiffness, joint effusion, joint swelling, joint warmth, injection site pain, arthritis, arthropathy, and gait disturbance.

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Commercial Payer Reimbursement for SYNVISC® (hylan G-F 20) and SYNVISC-ONE® (hylan G-F 20)

SYNVISC and SYNVISC-ONE commercial payer reimbursement

PHYSICIAN'S OFFICE

HOSPITAL OUTPATIENT

Specialty Pharmacy Forms

Educational Resources for Your Patients

Important Safety Information

Indication

For SYNVISC

For SYNVISC-ONE

Important Safety Information

Indication

Commercial Payer Reimbursement for SYNVISC^® (hylan G-F 20) and SYNVISC-ONE^® (hylan G-F 20)