As people age, the daily wear and tear on the body’s joints, especially the knees, causes the loss of cartilage and inflammation. This condition is called osteoarthritis and it can be very painful and cause difficulty moving because of resulting stiffness. Osteoarthritis, the most common joint disorder in the United States, affects the knee joints of 10 percent of all men, and 13 percent of all women over the age of 60.
Today, many physicians prescribe the drug Zilretta for people who have a decreased quality of life due to the pain and stiffness that osteoarthritis causes. Zilretta is an injectable suspension of a type of non-opioid corticosteroid that is injected into the affected knee joints. Many people who use Zilretta have relief from pain and stiffness that osteoarthritis has caused.
If you have been wondering about whether Zilretta is right for you, or if your Medicare benefits cover its cost, here are some of the facts.
What is Osteoarthritis?
Osteoarthritis occurs as the result of the wearing down of the protective cartilage between the joints. Without this protective tissue, the bones rub against each other causing discomfort and difficulty moving. Osteoarthritis is the most common type of arthritis and it most commonly affects the knees, hips, hands, and the spine. In most cases, osteoarthritis develops slowly, but continues to worsen over time.
Some of the symptoms of osteoarthritis include:
• Pain in the affected joint during movement or at rest after movement.
• Stiffness, especially in the morning or after sitting for a while.
• Tenderness when light pressure is applied.
• Loss of flexibility and loss of full range of the joint’s movement.
• Grating of the bones against each other.
• Bone spurs that feel like hard bumps on the joint.
• Swelling that is usually from inflammation of the soft tissue around the joint.
You may be at higher risk for osteoarthritis if some of these factors are true for you:
• You are over the age of 60.
• You are a woman.
• You are overweight.
• You have previous joint injuries, such as sports injuries.
• You have a hereditary predisposition for osteoarthritis.
• You have a metabolic disease such as diabetes or hemochromatosis.
How Does Zilretta Work?
Zilretta is an FDA-approved treatment for knee pain caused by osteoarthritis. It is a corticosteroid that your doctor injects into your knee joints. The injection is a single dose that has a slow release formula, so it lasts for three months or longer.
Drugs like Zilretta work by blocking the substances within the body that can cause inflammation. Due to this action, it may also suppress your immune system, making you more vulnerable to infection.You may not be a good candidate for drugs like Ziretta if you are taking some other medications or if there is the possibility for reactions due to other health conditions you have. Your health care provider will inform you whether you are a good candidate for this type of therapy.
While there is no cure for osteoarthritis, there are ways to slow its progression, like losing weight, eating a healthy diet, and getting gentle exercise. If you are living with constant pain and stiffness, your health care provider may suggest that you try Zilretta.
Medicare Coverage for Zilretta
Without Part B Medicare benefits, your out-of-pocket costs for one dose of Zilretta is over $600.00. This is the average price in the United States, but where you live and where you buy the drug from affects your final cost.
Original Medicare Part B (medical insurance) covers most injectable drugs when a licensed medical professional administers the drug and it is deemed medically necessary.
If you have Part B, your Medicare benefits will likely pay 80 percent of the Medicare-approved amount of these prescription drugs. You are responsible for paying 20 percent of that approved amount, and you may be responsible for a copayment if the drug is administered in a hospital outpatient setting.
The physician who prescribes the drug, as well as the pharmacy where you get it, must accept Medicare assignment. You may not self-administer the drug, and it must be given as part of your doctor’s service.
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