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2017-09-27 CSRO Submits Comments to Anthem

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CSRO and Allies Submit Comments to Anthem on Utilization Management Changes for Osteoarthritis Patients

Posted: September 27, 2017


As patient and physician advocates, the Coalition of State Rheumatology Organizations (CSRO) actively monitors changes that affect physician’s ability to effectively treat their patients and operate their practices. As such, the CSRO took note of and discussed Anthem’s clinical utilization management revisions to the use of Hyaluronan (HA) injections for osteoarthritis in the knee. Anthem has revised HA injections from medically necessary to not medically necessary for its policy holders.

CSRO and a number of state societies submitted comments to Anthem opposing the changes, and urging them to reverse course before patients lose coverage for their preferred and best course of treatment.

Highlights include:

  •  Ample evidence demonstrates the safety and efficacy of HA. A multitude of recently published peer-reviewed studies have found HA to be an effective treatment option for patients with knee osteoarthritis, including a comprehensive meta-analysis that concluded that in 29 RCTs with almost 5000 patients, HA had significant treatment effects compared to baseline values.
  • The rationale for reclassifying HA disregards ample evidence that supports and recommends HA as an effective treatment for knee osteoarthritis in certain patients and instead broadly concludes that HA is not medically necessary in all cases. Using questions regarding treatment efficacy for every patient as a means of excluding coverage for those who may continue to benefit from HA therapy puts those patients who have experienced inadequate relief from previous treatments at risk and will inevitably lead to an increase in negative health outcomes.
  • Reducing the use of HA injections will have unintended consequences for health resource utilization. HA reduces the use of NSAIDs, corticosteroids, and opioids, and delays total knee replacement.

Read CSRO’s full comments

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