New York
Provider Communications
New Medical Step Therapy Requirements
Clinical Criteria are publicly available on the provider website. Visit the Clinical Criteria page to search for specific criteria.
Clinical Criteria |
Preferred drug(s) |
Nonpreferred drug(s) |
ING-CC-0005 |
Euflexxa (J7323) Supartz FX (J7321) Durolane (J7318) Gelsyn-3 (J7328) |
Including but not limited to: · Gel-One (J7326) · GenVisc 850 (J7320) · Hymovis (J7322) · Monovisc (J7327) · Orthovisc (J7324) · Synvisc/Synvisc One (J7325) · TriVisc (J7329) · Hyalgan/Visco-3 (J7321) · Triluron (J7332) |
Featured In:
October 2021 Newsletter