MedicaidPrior AuthMedium impact
Viscosupplements (Revised)
Humana·FL, KY, SC, VA · Orthopedics, Rheumatology, Pain Management +1 more·Medicaid
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its viscosupplement prior authorization policy effective January 28, 2026, for four Medicaid state programs (FL, KY, SC, VA). The policy maintains prior authorization requirements for 18 viscosupplement products used to treat knee osteoarthritis, with specific clinical criteria including documented symptomatic knee OA, previous treatment/contraindication/intolerance with two specified products (except Florida), and 6-month intervals between treatment cycles. This is a routine policy revision with no substantive coverage changes.
Action Required
Before January 28, 2026: Verify that billing system reflects current prior authorization requirements for all 18 viscosupplement products (Durolane, Euflexxa, Gel-One, Gelsyn-3, GenVisc 850, Hyalgan, Hymovis, Hymovis-ONE, Monovisc, ORTHOVISC, Supartz FX, SynoJoynt, Synvisc, Synvisc-One, Triluron, TriVisc, Visco-3) for Humana Medicaid plans in FL, KY, SC, and VA. Billing team must confirm that prior authorization workflows require: (1) documentation of symptomatic knee OA, (2) for most products, evidence of prior treatment/contraindication/intolerance with at least 2 of the 5 first-line products (Durolane, Euflexxa, Gelsyn-3, Supartz FX—note: this requirement does NOT apply to Florida Medicaid), and (3) verification of 6-month interval since last treatment cycle for re-treatment requests. Update encounter forms and prior authorization templates if necessary. Claims submitted without required prior authorization will be denied. Note: Florida Medicaid requests are exempted from the 2-product prior treatment requirement.